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: $40.20 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $46.02 | Max safety net: $25.00 | General Patient Charge: $30.82 | ||
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: $40.20 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $47.96 | Max safety net: $25.00 | General Patient Charge: $32.76 | ||
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: $25.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $33.48 | Max safety net: $25.00 | General Patient Charge: $32.74 | ||
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: $28.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $36.50 | Max safety net: $25.00 | General Patient Charge: $32.76 | ||
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: $20.05 | Max safety net: $21.59 | General Patient Charge: $24.38 |
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DPMQ: $23.92 | Max safety net: $21.59 | General Patient Charge: $28.25 | ||
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: $27.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $31.16 | Max safety net: $25.00 | General Patient Charge: $28.88 | ||
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: $38.14 | 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: $27.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $30.19 | Max safety net: $25.00 | General Patient Charge: $27.91 | ||
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: $38.14 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $41.05 | Max safety net: $25.00 | General Patient Charge: $27.91 | ||
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: $21.55 | Max safety net: $23.09 | General Patient Charge: $25.00 |
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DPMQ: $25.43 | Max safety net: $23.09 | General Patient Charge: $28.88 | ||