VARENICLINE
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 6885)
Indication: Nicotine dependence
Treatment phase: Completion of a short-term (24 weeks) course of treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 2 | DPMQ: $71.27 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 7483)
Indication: Nicotine dependence
Treatment phase: Continuation of a short-term (12 weeks or 24 weeks) course of treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 0 | DPMQ: $129.50 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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