CLONAZEPAM
Body System:
Manner of administration:Oral
Restriction
Indication: Epilepsy
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 200 | # of repeats: 2 | DPMQ: $27.34 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction
Indication: For use in patients receiving palliative care
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 100 | # of repeats: 3 | DPMQ: $20.56 | Max safety net: $22.04 | General Patient Charge: $24.83 |
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