LEVODOPA + CARBIDOPA

LEVODOPA + CARBIDOPA (11910W)

levodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL
11910W
Body System:
Manner of administration:Intra-intestinal
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10161)

Indication: Advanced Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: $5,816.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duodopa

LEVODOPA + CARBIDOPA (11913B)

levodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL
11913B
Body System:
Manner of administration:Intra-intestinal
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10138)

Indication: Advanced Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: $5,768.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duodopa

LEVODOPA + CARBIDOPA (11919H)

levodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL
11919H
Body System:
Manner of administration:Intra-intestinal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10197)

Indication: Advanced Parkinson disease
Treatment phase: Maintenance therapy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: $5,903.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duodopa

LEVODOPA + CARBIDOPA (8970D)

levodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL
8970D
Body System:
Manner of administration:Intra-intestinal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10386)

Indication: Advanced Parkinson disease
Treatment phase: Maintenance therapy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 5 DPMQ: $11,698.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duodopa

LEVODOPA + CARBIDOPA (9743T)

levodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL
9743T
Body System:
Manner of administration:Intra-intestinal
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10375)

Indication: Advanced Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 5 DPMQ: $11,536.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duodopa

LEVODOPA + CARBIDOPA (9744W)

levodopa 20 mg/mL + carbidopa monohydrate 5 mg/mL intestinal gel, 7 x 100 mL
9744W
Body System:
Manner of administration:Intra-intestinal
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10363)

Indication: Advanced Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 5 DPMQ: $11,584.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duodopa