ROTIGOTINE

ROTIGOTINE (11140H)

rotigotine 8 mg/24 hours patch, 28
11140H
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: $109.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

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: $167.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

ROTIGOTINE (14327C)

rotigotine 2 mg/24 hours patch, 28
14327C
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: $127.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

ROTIGOTINE (14359R)

rotigotine 8 mg/24 hours patch, 28
14359R
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: $208.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

ROTIGOTINE (14431M)

rotigotine 6 mg/24 hours patch, 28
14431M
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: $188.50 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: $89.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

ROTIGOTINE (2385M)

rotigotine 2 mg/24 hours patch, 28
2385M
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: $70.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro

ROTIGOTINE (2410W)

rotigotine 6 mg/24 hours patch, 28
2410W
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: $99.66 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Neupro