CANNABIDIOL

CANNABIDIOL (12467E)

cannabidiol 100 mg/mL oral liquid, 100 mL
12467E
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Severe myoclonic epilepsy in infancy (Dravet syndrome)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $1,535.64 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Epidyolex

CANNABIDIOL (13277T)

cannabidiol 100 mg/mL oral liquid, 100 mL
13277T
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17678)

Indication: Seizures of the Lennox-Gastaut syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $1,535.64 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Epidyolex