TRAVOPROST

TRAVOPROST (14549R)

travoprost 0.004% eye drops, 2.5 mL
14549R
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: $53.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Travatan

TRAVOPROST (5554H)

travoprost 0.004% eye drops, 2.5 mL
5554H
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: $33.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Travatan

TRAVOPROST (8597L)

travoprost 0.004% eye drops, 2.5 mL
8597L
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: $33.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Travatan