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: $19.14 Max safety net: $20.68 General Patient Charge: $23.47
Available brands
Proxen SR 750
Naprosyn SR750
*Additional charge for this brand is $2.30
 DPMQ: $21.44 Max safety net: $20.68 General Patient Charge: $25.77

NAPROXEN (1615B)

naproxen 1 g modified release tablet, 28
1615B
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: $20.72 Max safety net: $22.26 General Patient Charge: $25.00
Available brands
Proxen SR 1000
Naprosyn SR1000
*Additional charge for this brand is $2.29
 DPMQ: $23.01 Max safety net: $22.26 General Patient Charge: $27.29

NAPROXEN (1795L)

naproxen sodium 550 mg tablet, 50
1795L
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: 50 # of repeats: 3 DPMQ: $19.75 Max safety net: $21.29 General Patient Charge: $24.08
Available brands
Crysanal
Anaprox 550
*Additional charge for this brand is $2.77
 DPMQ: $22.52 Max safety net: $21.29 General Patient Charge: $26.85

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: $19.14 Max safety net: $20.68 General Patient Charge: $23.47
Available brands
Proxen SR 750
Naprosyn SR750
*Additional charge for this brand is $2.30
 DPMQ: $21.44 Max safety net: $20.68 General Patient Charge: $25.77

NAPROXEN (5179N)

naproxen 1 g modified release tablet, 28
5179N
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: $20.72 Max safety net: $22.26 General Patient Charge: $25.00
Available brands
Proxen SR 1000
Naprosyn SR1000
*Additional charge for this brand is $2.29
 DPMQ: $23.01 Max safety net: $22.26 General Patient Charge: $27.29

NAPROXEN (5186Y)

naproxen sodium 550 mg tablet, 50
5186Y
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: 50 # of repeats: 0 DPMQ: $19.75 Max safety net: $21.29 General Patient Charge: $24.08
Available brands
Crysanal
Anaprox 550
*Additional charge for this brand is $2.77
 DPMQ: $22.52 Max safety net: $21.29 General Patient Charge: $26.85

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: $19.14 Max safety net: $20.68 General Patient Charge: $23.47
Available brands
Proxen SR 750
Naprosyn SR750
*Additional charge for this brand is $2.30
 DPMQ: $21.44 Max safety net: $20.68 General Patient Charge: $25.77

NAPROXEN (5348L)

naproxen 1 g modified release tablet, 28
5348L
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: $20.72 Max safety net: $22.26 General Patient Charge: $25.00
Available brands
Proxen SR 1000
Naprosyn SR1000
*Additional charge for this brand is $2.29
 DPMQ: $23.01 Max safety net: $22.26 General Patient Charge: $27.29

NAPROXEN (5353R)

naproxen sodium 550 mg tablet, 50
5353R
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: 50 # of repeats: 3 DPMQ: $19.75 Max safety net: $21.29 General Patient Charge: $24.08
Available brands
Crysanal
Anaprox 550
*Additional charge for this brand is $2.77
 DPMQ: $22.52 Max safety net: $21.29 General Patient Charge: $26.85