FLUTICASONE PROPIONATE

FLUTICASONE PROPIONATE (14347D)

fluticasone propionate 125 microgram/actuation inhalation, 120 actuations
14347D
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Restricted Benefit

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
Available brands
Axotide
Fluticasone Cipla Inhaler
Flixotide
*Additional charge for this brand is $5.82
 DPMQ: $46.02 Max safety net: $25.00 General Patient Charge: $30.82

FLUTICASONE PROPIONATE (8345F)

fluticasone propionate 125 microgram/actuation inhalation, 120 actuations
8345F
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
No restrictions
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
Available brands
Axotide
Fluticasone Cipla Inhaler
Flixotide
*Additional charge for this brand is $2.91
 DPMQ: $30.19 Max safety net: $25.00 General Patient Charge: $27.91

FLUTICASONE PROPIONATE (8346G)

fluticasone propionate 250 microgram/actuation inhalation, 120 actuations
8346G
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
No restrictions
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
Available brands
Axotide
Fluticasone Cipla Inhaler
Flixotide
*Additional charge for this brand is $2.91
 DPMQ: $41.05 Max safety net: $25.00 General Patient Charge: $27.91