ONDANSETRON

ondansetron 4 mg orally disintegrating tablet, 4
Manner of administration:Oral
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: 4 # of repeats: 0 DPMQ: $17.70 Max safety net: $19.18 General Patient Charge: $21.97
Available brands
APX-Ondansetron ODT
ONDANSETRON ODT-WGR
Ondansetron ODT Viatris
Ondansetron ODT-DRLA
Ondansetron SZ ODT
Zotren ODT
ondansetron 4 mg orally disintegrating tablet, 4
Manner of administration:Oral
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: 4 # of repeats: 0 DPMQ: $3.50 Max safety net: $4.98 General Patient Charge: $4.98
Available brands
APX-Ondansetron ODT
ONDANSETRON ODT-WGR
Ondansetron ODT Viatris
Ondansetron ODT-DRLA
Ondansetron SZ ODT
Zotren ODT