VIGABATRIN

VIGABATRIN (13919N)

vigabatrin 500 mg tablet, 100
13919N
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17444)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $163.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sabril

VIGABATRIN (13974L)

vigabatrin 500 mg powder for oral liquid, 60 sachets
13974L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17444)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $109.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sabril

VIGABATRIN (2667J)

vigabatrin 500 mg tablet, 100
2667J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17445)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $87.55 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sabril

VIGABATRIN (2668K)

vigabatrin 500 mg powder for oral liquid, 60 sachets
2668K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17445)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $61.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sabril