CARBOMER-980

CARBOMER-980 (14420Y)

carbomer-980 0.2% eye drops, 30 x 600 mg ampoules
14420Y
Body System:
Manner of administration:Application To The Eye
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15559)

Indication: Severe dry eye syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 5 DPMQ: $49.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Viscotears Gel PF

CARBOMER-980 (5504Q)

carbomer-980 0.2% eye drops, 30 x 600 mg ampoules
5504Q
Body System:
Manner of administration:Application To The Eye
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6172)

Indication: Severe dry eye syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $31.47 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Viscotears Gel PF

CARBOMER-980 (8578L)

carbomer-980 0.2% eye drops, 30 x 600 mg ampoules
8578L
Body System:
Manner of administration:Application To The Eye
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6172)

Indication: Severe dry eye syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $31.47 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Viscotears Gel PF