BUPRENORPHINE + NALOXONE

BUPRENORPHINE + NALOXONE (13321D)

buprenorphine 8 mg + naloxone 2 mg sublingual film, 28
13321D
Body System:
Manner of administration:Sublingual
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16009)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 112 # of repeats: 5 DPMQ: $510.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Suboxone Film 8/2

BUPRENORPHINE + NALOXONE (13322E)

buprenorphine 2 mg + naloxone 500 microgram sublingual film, 28
13322E
Body System:
Manner of administration:Sublingual
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16009)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 84 # of repeats: 5 DPMQ: $158.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Suboxone Film 2/0.5