SAFINAMIDE

SAFINAMIDE (11656L)

safinamide 50 mg tablet, 30
11656L
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $51.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Safinamide
XAFIMED
Xadago

SAFINAMIDE (11666B)

safinamide 100 mg tablet, 30
11666B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $88.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Safinamide
XAFIMED
Xadago

SAFINAMIDE (14391K)

safinamide 50 mg tablet, 30
14391K
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $88.42 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Safinamide
XAFIMED
Xadago

SAFINAMIDE (14528P)

safinamide 100 mg tablet, 30
14528P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $165.46 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Safinamide
XAFIMED
Xadago