RILUZOLE

RILUZOLE (11662T)

riluzole 50 mg/10 mL oral liquid, 300 mL
11662T
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Amyotrophic lateral sclerosis
Treatment phase: Initial treatment

Restriction

Indication: Amyotrophic lateral sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $205.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Teglutik

RILUZOLE (14429K)

riluzole 50 mg/10 mL oral liquid, 300 mL
14429K
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Amyotrophic lateral sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $402.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Teglutik