MEMANTINE
Body System:
Manner of administration:Oral
Restriction
Indication: Moderately severe Alzheimer disease
Treatment phase: Initial
Restriction
Indication: Moderately severe Alzheimer disease
Treatment phase: Initial
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $43.99 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 13966)
Indication: Moderately severe Alzheimer disease
Treatment phase: Continuing
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $43.99 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 13966)
Indication: Moderately severe Alzheimer disease
Treatment phase: Continuing
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $43.99 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
|
|
|||||
|
|
|||||
|
|
|||||
Body System:
Manner of administration:Oral
Restriction
Indication: Moderately severe Alzheimer disease
Treatment phase: Initial
Restriction
Indication: Moderately severe Alzheimer disease
Treatment phase: Initial
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $43.99 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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