PROPANTHELINE

PROPANTHELINE (13927B)

propantheline bromide 15 mg tablet, 100
13927B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Detrusor overactivity
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 400 # of repeats: 5 DPMQ: $35.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pro-Banthine

PROPANTHELINE (1953T)

propantheline bromide 15 mg tablet, 100
1953T
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Detrusor overactivity
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $24.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pro-Banthine