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: $17.16 Max safety net: $18.64 General Patient Charge: $21.43
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: $17.16 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Piroxicam