METHOTREXATE

General Schedule
Restricted Benefit

Restriction

Indication: Patients requiring doses greater than 20 mg per week
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 50 # of repeats: 2 DPMQ: $54.11 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Methotrexate
Chexate
Methoblastin