PEGINTERFERON ALFA-2A
peginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes
Body System:
Manner of administration:Injection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 4 | # of repeats: 5 | DPMQ: $935.71 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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peginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 17108)
Indication: Chronic hepatitis C infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 8 | # of repeats: 5 | DPMQ: $2,408.02 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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peginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 17022)
Indication: Chronic hepatitis C infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 8 | # of repeats: 5 | DPMQ: $2,359.14 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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peginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes
Body System:
Manner of administration:Injection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 4 | # of repeats: 5 | DPMQ: $1,304.19 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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peginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 17108)
Indication: Chronic hepatitis C infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 8 | # of repeats: 5 | DPMQ: $1,706.16 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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peginterferon alfa-2a 135 microgram/0.5 mL injection, 4 x 0.5 mL syringes
Body System:
Manner of administration:Injection
Restriction (Streamlined authority code: 17022)
Indication: Chronic hepatitis C infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 8 | # of repeats: 5 | DPMQ: $1,657.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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