DARUNAVIR

DARUNAVIR (10329P)

darunavir 600 mg tablet, 60
10329P
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5094)

Indication: Human immunodeficiency virus (HIV) 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: 120 # of repeats: 5 DPMQ: $1,373.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Prezista

DARUNAVIR (10367P)

darunavir 800 mg tablet, 30
10367P
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4313)

Indication: Human immunodeficiency virus (HIV) 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: $810.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Prezista

DARUNAVIR (12111K)

darunavir 800 mg tablet, 30
12111K
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4313)

Indication: Human immunodeficiency virus (HIV) 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: $810.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Darunavir Juno

DARUNAVIR (12946J)

darunavir 600 mg tablet, 2 x 30
12946J
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5094)

Indication: Human immunodeficiency virus (HIV) 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: 120 # of repeats: 5 DPMQ: $1,204.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Darunavir Juno