IPRATROPIUM

IPRATROPIUM (1542E)

ipratropium bromide 250 microgram/mL inhalation solution, 30 x 1 mL ampoules
1542E
Body System:
Manner of administration:Inhalation
General Schedule
Restricted Benefit

Restriction

Indication: Asthma

Restriction

Indication: Chronic obstructive pulmonary disease (COPD)
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: 5 DPMQ: $27.58 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Atrovent

IPRATROPIUM (8238N)

ipratropium bromide 500 microgram/mL inhalation solution, 30 x 1 mL ampoules
8238N
Body System:
Manner of administration:Inhalation
General Schedule
Restricted Benefit

Restriction

Indication: Asthma

Restriction

Indication: Chronic obstructive pulmonary disease (COPD)
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: 5 DPMQ: $30.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Atrovent Adult

IPRATROPIUM (8671J)

ipratropium bromide monohydrate 21 microgram/actuation inhalation, 200 actuations
8671J
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
No restrictions
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: 5 DPMQ: $34.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Atrovent
Cipla Ipratropium