PALOVAROTENE

PALOVAROTENE (14966Q)

palovarotene 5 mg capsule, 28
14966Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Fibrodysplasia ossificans progressiva (FOP)
Treatment phase: Chronic treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $50,114.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sohonos

PALOVAROTENE (14981L)

palovarotene 5 mg capsule, 28
14981L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17018)

Indication: Fibrodysplasia ossificans progressiva (FOP)
Treatment phase: Flare-up (acute) treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 2 DPMQ: $50,114.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sohonos