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: $33.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BrinzoQuin
Azopt
*Additional charge for this brand is $13.18
 DPMQ: $46.44 Max safety net: $25.00 General Patient Charge: $38.18

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: $23.81 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BrinzoQuin
Azopt
*Additional charge for this brand is $6.59
 DPMQ: $30.40 Max safety net: $25.00 General Patient Charge: $31.59

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: $23.81 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BrinzoQuin
Azopt
*Additional charge for this brand is $6.59
 DPMQ: $30.40 Max safety net: $25.00 General Patient Charge: $31.59