MYCOPHENOLATE
Manner of administration:Oral
Restriction
Indication: The condition must be stable for the prescriber to consider the listed maximum quantity
of this medicine suitable for this patient.
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 240 | # of repeats: 5 | DPMQ: $202.50 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 120 | # of repeats: 5 | DPMQ: $106.03 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 9692)
Indication: Prophylaxis of renal allograft rejection
Treatment phase: Management
Restriction (Streamlined authority code: 9809)
Indication: WHO Class III, IV or V lupus nephritis
Treatment phase: Management
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 240 | # of repeats: 5 | DPMQ: $187.32 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 4084)
Indication: Prophylaxis of renal allograft rejection
Treatment phase: Management
Restriction (Streamlined authority code: 4095)
Indication: WHO Class III, IV or V lupus nephritis
Treatment phase: Management
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 240 | # of repeats: 5 | DPMQ: $171.58 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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