RISEDRONATE

General Schedule
Restricted Benefit

Restriction

Indication: Corticosteroid-induced osteoporosis

Restriction

Indication: Osteoporosis

Restriction

Indication: Established osteoporosis
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: $61.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Actonel
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Preservation of bone mineral density
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: - Max safety net: - General Patient Charge: -
Available brands
Actonel DPMQ: $61.82 Max safety net: $7.70 General Patient Charge: $7.70
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Preservation of bone mineral density
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: - Max safety net: - General Patient Charge: -
Available brands
Actonel DPMQ: $37.80 Max safety net: $7.70 General Patient Charge: $7.70
General Schedule
Restricted Benefit

Restriction

Indication: Corticosteroid-induced osteoporosis

Restriction

Indication: Osteoporosis

Restriction

Indication: Established osteoporosis
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: $37.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Actonel