DORZOLAMIDE

DORZOLAMIDE (14524K)

dorzolamide 2% eye drops, 5 mL
14524K
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: $24.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Trusamide
Trusopt

DORZOLAMIDE (5541P)

dorzolamide 2% eye drops, 5 mL
5541P
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: $19.09 Max safety net: $20.57 General Patient Charge: $23.36
Available brands
Trusamide
Trusopt

DORZOLAMIDE (8488R)

dorzolamide 2% eye drops, 5 mL
8488R
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: $19.09 Max safety net: $20.57 General Patient Charge: $23.36
Available brands
Trusamide
Trusopt