DIMETHYL FUMARATE

DIMETHYL FUMARATE (2896K)

dimethyl fumarate 120 mg enteric capsule, 14
2896K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16323)

Indication: Multiple sclerosis
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 28 # of repeats: 0 DPMQ: $213.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-DIMETHYL FUMARATE
Dimethyl Fumarate Sandoz
Pharmacor Dimethyl Fumarate
Tecfidera

DIMETHYL FUMARATE (2943X)

dimethyl fumarate 120 mg enteric capsule, 14
2943X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16315)

Indication: Multiple sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 28 # of repeats: 0 DPMQ: $213.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-DIMETHYL FUMARATE
Dimethyl Fumarate Sandoz
Pharmacor Dimethyl Fumarate
Tecfidera

DIMETHYL FUMARATE (2966D)

dimethyl fumarate 240 mg enteric capsule, 56
2966D
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16315)

Indication: Multiple sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $348.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-DIMETHYL FUMARATE
Dimethyl Fumarate Sandoz
Pharmacor Dimethyl Fumarate
Tecfidera
Trazent