RILUZOLE
Body System:
Manner of administration:Oral
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 | |||||
Body System:
Manner of administration:Oral
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: 112 | # of repeats: 5 | DPMQ: $209.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
|
|
|||||
|
|
|||||
|
|
|||||
Body System:
Manner of administration:Oral
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 | |||||
Body System:
Manner of administration:Oral
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: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $109.53 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
|
|
|||||
|
|
|||||
|
|
|||||