ROTIGOTINE

ROTIGOTINE (14326B)

rotigotine 4 mg/24 hours patch, 28
14326B
Body System:
Manner of administration:Transdermal
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $171.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

ROTIGOTINE (2384L)

rotigotine 4 mg/24 hours patch, 28
2384L
Body System:
Manner of administration:Transdermal
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
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: $91.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro