NAPROXEN

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Indication: Chronic arthropathies (including osteoarthritis)

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: $20.35	Max safety net: $21.83	General Patient Charge: $24.62
Available brands
Proxen SR 1000
Naprosyn SR1000 *Additional charge for this brand is $2.35			DPMQ: $22.70	Max safety net: $21.83	General Patient Charge: $26.97

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Indication: Chronic arthropathies (including osteoarthritis)

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: $20.35	Max safety net: $21.83	General Patient Charge: $24.62
Available brands
Proxen SR 1000
Naprosyn SR1000 *Additional charge for this brand is $2.35			DPMQ: $22.70	Max safety net: $21.83	General Patient Charge: $26.97

Body System:

Manner of administration:Oral

Palliative Care

Restricted Benefit

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: $20.35	Max safety net: $21.83	General Patient Charge: $24.62
Available brands
Proxen SR 1000
Naprosyn SR1000 *Additional charge for this brand is $2.35			DPMQ: $22.70	Max safety net: $21.83	General Patient Charge: $26.97

NAPROXEN (1615B)