SOFOSBUVIR + VELPATASVIR + VOXILAPREVIR

SOFOSBUVIR + VELPATASVIR + VOXILAPREVIR (11658N)

sofosbuvir 400 mg + velpatasvir 100 mg + voxilaprevir 100 mg tablet, 28
11658N
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 2 DPMQ: $12,037.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vosevi

SOFOSBUVIR + VELPATASVIR + VOXILAPREVIR (11659P)

sofosbuvir 400 mg + velpatasvir 100 mg + voxilaprevir 100 mg tablet, 28
11659P
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required

Restriction

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 2 DPMQ: $11,923.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vosevi

SOFOSBUVIR + VELPATASVIR + VOXILAPREVIR (11665Y)

sofosbuvir 400 mg + velpatasvir 100 mg + voxilaprevir 100 mg tablet, 28
11665Y
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required

Restriction

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 2 DPMQ: $11,875.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vosevi