FLUTICASONE PROPIONATE
fluticasone propionate 125 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction
Indication: The condition must be stable for the prescriber to consider the listed maximum quantity
of this medicine suitable for this patient.
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: $40.44 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $46.44 | Max safety net: $25.00 | General Patient Charge: $31.00 | ||
fluticasone propionate 250 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
Restriction
Indication: The condition must be stable for the prescriber to consider the listed maximum quantity
of this medicine suitable for this patient.
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: $40.44 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $48.44 | Max safety net: $25.00 | General Patient Charge: $33.00 | ||
fluticasone propionate 100 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
Restriction
Indication: The condition must be stable for the prescriber to consider the listed maximum quantity
of this medicine suitable for this patient.
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: $25.52 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $33.52 | Max safety net: $25.00 | General Patient Charge: $33.00 | ||
fluticasone propionate 50 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15854)
Indication: Asthma
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: $28.62 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $36.62 | Max safety net: $25.00 | General Patient Charge: $33.00 | ||
fluticasone propionate 100 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
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: $19.65 | Max safety net: $21.13 | General Patient Charge: $23.92 |
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DPMQ: $23.65 | Max safety net: $21.13 | General Patient Charge: $27.92 | ||
fluticasone propionate 250 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
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: $27.11 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $31.11 | Max safety net: $25.00 | General Patient Charge: $29.00 | ||
fluticasone propionate 500 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
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: 1 | DPMQ: $38.30 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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| Flixotide Accuhaler | |||||
fluticasone propionate 125 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
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: $27.11 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $30.11 | Max safety net: $25.00 | General Patient Charge: $28.00 | ||
fluticasone propionate 250 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
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: 1 | DPMQ: $38.30 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $41.30 | Max safety net: $25.00 | General Patient Charge: $28.00 | ||
fluticasone propionate 50 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 14180)
Indication: Asthma
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: $21.20 | Max safety net: $22.68 | General Patient Charge: $25.00 |
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DPMQ: $25.20 | Max safety net: $22.68 | General Patient Charge: $29.00 | ||