DEFERIPRONE

DEFERIPRONE (11724C)

deferiprone 1 g tablet, 50
11724C
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9623)

Indication: Iron overload

Restriction (Streamlined authority code: 9590)

Indication: Iron overload
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 300 # of repeats: 5 DPMQ: $2,360.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ferriprox

DEFERIPRONE (11747G)

deferiprone 1 g tablet, 50
11747G
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: 6 Max qty units: 300 # of repeats: 5 DPMQ: $2,311.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ferriprox

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 (5658T)

deferiprone 100 mg/mL oral liquid, 250 mL
5658T
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: 5 Max qty units: 5 # of repeats: 5 DPMQ: $963.10 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

DEFERIPRONE (9638G)

deferiprone 100 mg/mL oral liquid, 250 mL
9638G
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: 5 Max qty units: 5 # of repeats: 5 DPMQ: $1,010.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ferriprox