PILOCARPINE
Body System:
Manner of administration:Application To The Eye
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: 2 | # of repeats: 5 | DPMQ: $24.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
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: 2 | # of repeats: 5 | DPMQ: $26.78 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
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: 2 | # of repeats: 5 | DPMQ: $31.60 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $19.54 | Max safety net: $21.08 | General Patient Charge: $23.87 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $20.57 | Max safety net: $22.11 | General Patient Charge: $24.90 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $22.98 | Max safety net: $24.52 | General Patient Charge: $25.00 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $19.54 | Max safety net: $21.08 | General Patient Charge: $23.87 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $20.57 | Max safety net: $22.11 | General Patient Charge: $24.90 |
| Available brands | |||||
| Isopto Carpine | |||||
Body System:
Manner of administration:Application To The Eye
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $22.98 | Max safety net: $24.52 | General Patient Charge: $25.00 |
| Available brands | |||||
| Isopto Carpine | |||||