LEVODOPA + CARBIDOPA

LEVODOPA + CARBIDOPA (1255C)

levodopa 200 mg + carbidopa 50 mg modified release tablet, 100
1255C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $69.65 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sinemet CR

LEVODOPA + CARBIDOPA (14322T)

levodopa 200 mg + carbidopa 50 mg modified release tablet, 100
14322T
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $126.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sinemet CR