CALCIPOTRIOL + BETAMETHASONE DIPROPIONATE
calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% foam, 60 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 1 | DPMQ: $84.44 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $94.09 | Max safety net: $25.00 | General Patient Charge: $34.65 | ||
calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% foam, 60 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 1 | DPMQ: $156.52 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $176.80 | Max safety net: $25.00 | General Patient Charge: $45.28 | ||
calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% ointment, 30 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 1 | DPMQ: $64.06 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% cream, 60 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 1 | DPMQ: $64.07 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Wynzora 50/500 | |||||
Calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% cream, 60 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 1 | DPMQ: $113.78 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Wynzora 50/500 | |||||
calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% gel, 60 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 1 | DPMQ: $113.78 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Actobet 50/500 | |||||
calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% gel, 60 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 1 | DPMQ: $64.07 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Actobet 50/500 | |||||
calcipotriol 0.005% + betamethasone (as dipropionate) 0.05% ointment, 30 g
Body System:
Manner of administration:Application
Restriction
Indication: Chronic stable plaque type psoriasis vulgaris
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 1 | DPMQ: $39.21 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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