TRAVOPROST + TIMOLOL

TRAVOPROST + TIMOLOL (14316L)

travoprost 0.004% + timolol 0.5% eye drops, 2.5 mL
14316L
Body System:
Manner of administration:Application To The Eye
General Schedule
Restricted Benefit

Restriction

Indication: Elevated intra-ocular pressure
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: $59.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duotrav

TRAVOPROST + TIMOLOL (5555J)

travoprost 0.004% + timolol 0.5% eye drops, 2.5 mL
5555J
Body System:
Manner of administration:Application To The Eye
General Schedule
Restricted Benefit

Restriction

Indication: Elevated intra-ocular pressure
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: $36.47 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duotrav

TRAVOPROST + TIMOLOL (9057Q)

travoprost 0.004% + timolol 0.5% eye drops, 2.5 mL
9057Q
Body System:
Manner of administration:Application To The Eye
General Schedule
Restricted Benefit

Restriction

Indication: Elevated intra-ocular pressure
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: $36.47 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Duotrav