FAMCICLOVIR

FAMCICLOVIR (2274Q)

famciclovir 250 mg tablet, 20
2274Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5937)

Indication: Recurrent moderate to severe genital herpes
Treatment phase: Episodic treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 20 # of repeats: 1 DPMQ: $32.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Famciclovir
FAMCICLOVIR-WGR
Famvir
Favic 250

FAMCICLOVIR (8002E)

famciclovir 250 mg tablet, 21
8002E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5951)

Indication: Herpes zoster
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 21 # of repeats: 0 DPMQ: $33.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Famciclovir
Ezovir
FAMCICLOVIR-WGR
Famvir
Favic 250

FAMCICLOVIR (8092X)

famciclovir 125 mg tablet, 40
8092X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5937)

Indication: Recurrent moderate to severe genital herpes
Treatment phase: Episodic treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 40 # of repeats: 1 DPMQ: $32.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Famciclovir
Famvir
Favic 125

FAMCICLOVIR (8217L)

famciclovir 250 mg tablet, 56
8217L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5971)

Indication: Recurrent moderate to severe genital herpes
Treatment phase: Suppressive therapy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $66.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Famciclovir
Ezovir
FAMCICLOVIR-WGR
Famvir
Favic 250

FAMCICLOVIR (8896F)

famciclovir 500 mg tablet, 56
8896F
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5954)

Indication: Recurrent moderate to severe genital herpes
Treatment phase: Episodic treatment or suppressive therapy

Restriction (Streamlined authority code: 5947)

Indication: Recurrent moderate to severe oral or labial herpes
Treatment phase: Episodic treatment

Restriction (Streamlined authority code: 5948)

Indication: Recurrent moderate to severe oral or labial herpes
Treatment phase: Suppressive therapy

Restriction (Streamlined authority code: 5949)

Indication: Recurrent moderate to severe oral or labial herpes
Treatment phase: Suppressive therapy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $66.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Famciclovir
Ezovir
FAMCICLOVIR-WGR
Famvir
Favic 500

FAMCICLOVIR (8897G)

famciclovir 500 mg tablet, 30
8897G
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5943)

Indication: Herpes zoster
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 0 DPMQ: $41.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Famciclovir
FAMCICLOVIR-WGR
Famvir
Favic 500