GRANISETRON

GRANISETRON (5898K)

granisetron 2 mg tablet, 1
5898K
Body System:
Manner of administration:Oral
Section 100 (CT)
Restricted Benefit

Restriction

Indication: Nausea and vomiting
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: 0 DPMQ: $16.58 Max safety net: $18.06 General Patient Charge: $18.06
Available brands
Kytril

GRANISETRON (8728J)

granisetron 2 mg tablet, 1
8728J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Nausea and vomiting
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: 0 DPMQ: $31.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kytril

GRANISETRON (8873B)

granisetron 2 mg tablet, 5
8873B
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10498)

Indication: Nausea and vomiting
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 5 # of repeats: 1 DPMQ: $58.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kytril