BRINZOLAMIDE

BRINZOLAMIDE (14321R)

brinzolamide 1% eye drops, 5 mL
14321R
Body System:
Manner of administration:Application To The Eye
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $33.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BrinzoQuin
Azopt
*Additional charge for this brand is $13.60
 DPMQ: $46.88 Max safety net: $25.00 General Patient Charge: $38.60

BRINZOLAMIDE (5540N)

brinzolamide 1% eye drops, 5 mL
5540N
Body System:
Manner of administration:Application To The Eye
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $23.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BrinzoQuin
Azopt
*Additional charge for this brand is $6.80
 DPMQ: $30.33 Max safety net: $25.00 General Patient Charge: $31.80

BRINZOLAMIDE (8483L)

brinzolamide 1% eye drops, 5 mL
8483L
Body System:
Manner of administration:Application To The Eye
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $23.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BrinzoQuin
Azopt
*Additional charge for this brand is $6.80
 DPMQ: $30.33 Max safety net: $25.00 General Patient Charge: $31.80