APIXABAN
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 14301)
Indication: Prevention of stroke or systemic embolism
Restriction (Streamlined authority code: 14300)
Indication: Prevention of recurrent venous thromboembolism
Treatment phase: Continuing 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: 120 | # of repeats: 5 | DPMQ: $122.78 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 14301)
Indication: Prevention of stroke or systemic embolism
Restriction (Streamlined authority code: 18525)
Indication: Deep vein thrombosis
Restriction (Streamlined authority code: 18527)
Indication: Pulmonary embolism
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 120 | # of repeats: 5 | DPMQ: $119.76 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 4269)
Indication: Prevention of stroke or systemic embolism
Restriction (Streamlined authority code: 18513)
Indication: Deep vein thrombosis
Restriction (Streamlined authority code: 18522)
Indication: Pulmonary embolism
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 60 | # of repeats: 5 | DPMQ: $66.93 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 4269)
Indication: Prevention of stroke or systemic embolism
Restriction (Streamlined authority code: 4132)
Indication: Prevention of recurrent venous thromboembolism
Treatment phase: Continuing 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: 60 | # of repeats: 5 | DPMQ: $68.37 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 4382)
Indication: Prevention of venous thromboembolism
Restriction (Streamlined authority code: 4409)
Indication: Prevention of venous thromboembolism
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 30 | # of repeats: 0 | DPMQ: $41.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 4402)
Indication: Prevention of venous thromboembolism
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 60 | # of repeats: 0 | DPMQ: $68.37 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 4381)
Indication: Prevention of venous thromboembolism
Restriction (Streamlined authority code: 4359)
Indication: Prevention of venous thromboembolism
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 20 | # of repeats: 0 | DPMQ: $32.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eliquis | |||||