DEFERIPRONE

DEFERIPRONE (5657R)

deferiprone 500 mg tablet, 100
5657R
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6448)

Indication: Iron overload

Restriction (Streamlined authority code: 6403)

Indication: Iron overload
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 300 # of repeats: 5 DPMQ: $1,155.69 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ferriprox

DEFERIPRONE (6416Q)

deferiprone 500 mg tablet, 100
6416Q
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9286)

Indication: Iron overload

Restriction (Streamlined authority code: 9228)

Indication: Iron overload
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 300 # of repeats: 5 DPMQ: $1,204.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ferriprox