NAPROXEN

NAPROXEN (1614Y)

naproxen 750 mg modified release tablet, 28
1614Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic arthropathies (including osteoarthritis)

Restriction

Indication: Bone pain
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: 3 DPMQ: $18.74 Max safety net: $20.22 General Patient Charge: $23.01
Available brands
Proxen SR 750
Naprosyn SR750
*Additional charge for this brand is $2.35
 DPMQ: $21.09 Max safety net: $20.22 General Patient Charge: $25.36

NAPROXEN (5178M)

naproxen 750 mg modified release tablet, 28
5178M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic arthropathies (including osteoarthritis)

Restriction

Indication: Bone pain
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: 0 DPMQ: $18.74 Max safety net: $20.22 General Patient Charge: $23.01
Available brands
Proxen SR 750
Naprosyn SR750
*Additional charge for this brand is $2.35
 DPMQ: $21.09 Max safety net: $20.22 General Patient Charge: $25.36

NAPROXEN (5347K)

naproxen 750 mg modified release tablet, 28
5347K
Body System:
Manner of administration:Oral
Palliative Care
Restricted Benefit

Restriction

Indication: Severe pain
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: 3 DPMQ: $18.74 Max safety net: $20.22 General Patient Charge: $23.01
Available brands
Proxen SR 750
Naprosyn SR750
*Additional charge for this brand is $2.35
 DPMQ: $21.09 Max safety net: $20.22 General Patient Charge: $25.36