ESKETAMINE
Body System:
Manner of administration:Nasal
Restriction
Indication: Treatment resistant major depression
Treatment phase: Induction treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 24 | # of repeats: 0 | DPMQ: $7,228.30 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Spravato | |||||
Body System:
Manner of administration:Nasal
Restriction
Indication: Treatment resistant major depression
Treatment phase: Non-induction treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 12 | # of repeats: 5 | DPMQ: $3,584.30 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Spravato | |||||
Body System:
Manner of administration:Nasal
Restriction
Indication: Treatment resistant major depression
Treatment phase: Non-induction treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 12 | # of repeats: 5 | DPMQ: $3,529.92 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Spravato | |||||
Body System:
Manner of administration:Nasal
Restriction
Indication: Treatment resistant major depression
Treatment phase: Induction treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 24 | # of repeats: 0 | DPMQ: $7,114.22 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Spravato | |||||
Body System:
Manner of administration:Nasal
Restriction
Indication: Treatment resistant major depression
Treatment phase: Non-induction treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 12 | # of repeats: 5 | DPMQ: $3,671.30 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Spravato | |||||
Body System:
Manner of administration:Nasal
Restriction
Indication: Treatment resistant major depression
Treatment phase: Induction treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 24 | # of repeats: 0 | DPMQ: $7,059.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Spravato | |||||