MESALAZINE

MESALAZINE (13247F)

mesalazine 1.2 g modified release tablet, 120
13247F
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ulcerative colitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 120 # of repeats: 5 DPMQ: $173.91 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
MESALZ

MESALAZINE (13356Y)

mesalazine 1.2 g modified release tablet, 120
13356Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ulcerative colitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 240 # of repeats: 5 DPMQ: $339.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
MESALZ