FOSLEVODOPA + FOSCARBIDOPA
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16951)
Indication: Advanced Parkinson disease
Treatment phase: Maintenance therapy
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 56 | # of repeats: 5 | DPMQ: $10,116.32 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16853)
Indication: Advanced Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 56 | # of repeats: 5 | DPMQ: $10,116.32 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16812)
Indication: Advanced Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 28 | # of repeats: 5 | DPMQ: $5,112.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16883)
Indication: Advanced Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 28 | # of repeats: 5 | DPMQ: $5,025.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16882)
Indication: Advanced Parkinson disease
Treatment phase: Maintenance therapy
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 28 | # of repeats: 5 | DPMQ: $5,112.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16812)
Indication: Advanced Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 28 | # of repeats: 5 | DPMQ: $4,976.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16972)
Indication: Advanced Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 56 | # of repeats: 5 | DPMQ: $10,002.24 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||
foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 16853)
Indication: Advanced Parkinson disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 8 | Max qty units: 56 | # of repeats: 5 | DPMQ: $9,953.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Vyalev | |||||