TERBINAFINE
Manner of administration:Oral
Restriction
Indication: Dermatophyte infection
Restriction
Indication: Dermatophyte infection
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 42 | # of repeats: 0 | DPMQ: $26.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction
Indication: Onychomycosis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 42 | # of repeats: 1 | DPMQ: $26.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction
Indication: Onychomycosis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 42 | # of repeats: 1 | DPMQ: - | Max safety net: - | General Patient Charge: - |
| Available brands | |||||
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DPMQ: $26.56 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $26.56 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $26.56 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $26.56 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $26.56 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
Body System:
Manner of administration:Application
Restriction
Indication: Tinea pedis
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: 0 | DPMQ: - | Max safety net: - | General Patient Charge: - |
| Available brands | |||||
| Lamisil DermGel | DPMQ: $28.51 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
Body System:
Manner of administration:Application
Restriction
Indication: Tinea pedis
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: 1 | DPMQ: - | Max safety net: - | General Patient Charge: - |
| Available brands | |||||
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DPMQ: $27.24 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $27.24 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $27.24 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
Body System:
Manner of administration:Application
Restriction (Streamlined authority code: 6434)
Indication: Fungal or yeast infection
Restriction (Streamlined authority code: 6412)
Indication: Fungal or yeast infection
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: 3 | DPMQ: $40.70 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Lamisil | |||||
