SELEXIPAG

SELEXIPAG (12241G)

selexipag 200 microgram tablet, 140
12241G
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required

Restriction

Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial treatment - dose titration
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 140 # of repeats: 2 DPMQ: $7,696.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Uptravi

SELEXIPAG (12258E)

selexipag 200 microgram tablet, 140
12258E
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required

Restriction

Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial treatment - dose titration
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 140 # of repeats: 2 DPMQ: $7,647.50 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Uptravi