INSULIN LISPRO

INSULIN LISPRO (11645X)

insulin lispro 200 units/mL injection, 5 x 3 mL pen devices
11645X
Body System:
Manner of administration:Injection
General Schedule
No restrictions
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: 1 DPMQ: $267.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Humalog U200 Kwikpen

INSULIN LISPRO (12237C)

insulin lispro 100 units/mL injection, 5 x 3 mL pen devices
12237C
Body System:
Manner of administration:Injection
General Schedule
No restrictions
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: 1 DPMQ: $167.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Humalog KwikPen

INSULIN LISPRO (8084L)

insulin lispro 100 units/mL injection, 1 x 10 mL vial
8084L
Body System:
Manner of administration:Injection
General Schedule
No restrictions
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: 2 DPMQ: $101.58 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Humalog

INSULIN LISPRO (8212F)

insulin lispro 100 units/mL injection, 5 x 3 mL cartridges
8212F
Body System:
Manner of administration:Injection
General Schedule
No restrictions
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: 1 DPMQ: $167.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Humalog