PIROXICAM

PIROXICAM (1897W)

piroxicam 10 mg capsule, 50
1897W
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic arthropathies (including osteoarthritis)
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: $18.75 Max safety net: $20.29 General Patient Charge: $23.08
Available brands
APO-Piroxicam

PIROXICAM (1898X)

piroxicam 20 mg capsule, 25
1898X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic arthropathies (including osteoarthritis)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 25 # of repeats: 3 DPMQ: $17.56 Max safety net: $19.10 General Patient Charge: $21.89
Available brands
APO-Piroxicam

PIROXICAM (5203W)

piroxicam 10 mg capsule, 50
5203W
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic arthropathies (including osteoarthritis)
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: $18.75 Max safety net: $20.29 General Patient Charge: $23.08
Available brands
APO-Piroxicam

PIROXICAM (5204X)

piroxicam 20 mg capsule, 25
5204X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Chronic arthropathies (including osteoarthritis)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 25 # of repeats: 0 DPMQ: $17.56 Max safety net: $19.10 General Patient Charge: $21.89
Available brands
APO-Piroxicam