PALONOSETRON

PALONOSETRON (5295Q)

palonosetron 250 microgram/5 mL injection, 5 mL vial
5295Q
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Nausea and vomiting
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $24.45 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
PALONOSETRON Medsurge
Palonosetron Dr.Reddy's
Palonosetron JN

PALONOSETRON (5853C)

palonosetron 250 microgram/5 mL injection, 5 mL vial
5853C
Body System:
Manner of administration:Injection
Section 100 (CT)
Restricted Benefit

Restriction

Indication: Nausea and vomiting
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $9.91 Max safety net: $11.39 General Patient Charge: $11.39
Available brands
PALONOSETRON Medsurge
Palonosetron Dr.Reddy's
Palonosetron JN