SELEXIPAG

SELEXIPAG (12235Y)

selexipag 400 microgram tablet, 60
12235Y
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required

Restriction

Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial treatment following dose titration

Restriction

Indication: Pulmonary arterial hypertension (PAH)
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: 60 # of repeats: 5 DPMQ: $3,277.50 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Uptravi

SELEXIPAG (12260G)

selexipag 400 microgram tablet, 60
12260G
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required

Restriction

Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial treatment following dose titration

Restriction

Indication: Pulmonary arterial hypertension (PAH)
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: 60 # of repeats: 5 DPMQ: $3,326.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Uptravi