DESMOPRESSIN

DESMOPRESSIN (15313Y)

Desmopressin 120 microgram sublingual tablet, 30
15313Y
Body System:
Manner of administration:Sublingual
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5412)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 5226)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $50.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Desmopressin ADVZ

DESMOPRESSIN (15323L)

Desmopressin 120 microgram sublingual tablet, 30
15323L
Body System:
Manner of administration:Sublingual
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14972)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 14842)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $87.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Desmopressin ADVZ