TACROLIMUS
Manner of administration:Oral
Restriction (Streamlined authority code: 5569)
Indication: Management of rejection in patients following organ or tissue transplantation
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 100 | # of repeats: 3 | DPMQ: $658.20 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 50 | # of repeats: 2 | DPMQ: $380.33 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 9697)
Indication: Management of rejection in patients following organ or tissue transplantation
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 100 | # of repeats: 3 | DPMQ: $693.40 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction
Indication: The condition must be stable for the prescriber to consider the listed maximum quantity
of this medicine suitable for this patient.
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 100 | # of repeats: 2 | DPMQ: $751.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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