TENOFOVIR DISOPROXIL

TENOFOVIR DISOPROXIL (10310P)

tenofovir disoproxil fumarate 300 mg tablet, 30
10310P
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6998)

Indication: HIV infection
Treatment phase: Initial

Restriction (Streamlined authority code: 6982)

Indication: HIV infection
Treatment phase: Continuing

Restriction (Streamlined authority code: 6980)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6992)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6983)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6984)

Indication: Chronic hepatitis B infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $126.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
TENOFOVIR ARX
Tenofovir Sandoz

TENOFOVIR DISOPROXIL (11142K)

tenofovir disoproxil phosphate 291 mg tablet, 30
11142K
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6998)

Indication: HIV infection
Treatment phase: Initial

Restriction (Streamlined authority code: 6982)

Indication: HIV infection
Treatment phase: Continuing

Restriction (Streamlined authority code: 6980)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6992)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6983)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6984)

Indication: Chronic hepatitis B infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $90.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tenofovir GH

TENOFOVIR DISOPROXIL (11155D)

tenofovir disoproxil maleate 300 mg tablet, 30
11155D
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6998)

Indication: HIV infection
Treatment phase: Initial

Restriction (Streamlined authority code: 6982)

Indication: HIV infection
Treatment phase: Continuing

Restriction (Streamlined authority code: 6980)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6992)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6983)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 6984)

Indication: Chronic hepatitis B infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $90.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tenofovir Disoproxil Viatris

TENOFOVIR DISOPROXIL (11978K)

tenofovir disoproxil phosphate 291 mg tablet, 30
11978K
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10362)

Indication: Chronic hepatitis B infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 2 DPMQ: $90.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tenofovir GH

TENOFOVIR DISOPROXIL (11982P)

tenofovir disoproxil maleate 300 mg tablet, 30
11982P
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10362)

Indication: Chronic hepatitis B infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 2 DPMQ: $90.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tenofovir Disoproxil Viatris

TENOFOVIR DISOPROXIL (11992E)

tenofovir disoproxil fumarate 300 mg tablet, 30
11992E
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10362)

Indication: Chronic hepatitis B infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 2 DPMQ: $126.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
TENOFOVIR ARX
Tenofovir Sandoz