ENTACAPONE

ENTACAPONE (14542J)

entacapone 200 mg tablet, 100
14542J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 400 # of repeats: 4 DPMQ: $350.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Comtan

ENTACAPONE (8367J)

entacapone 200 mg tablet, 100
8367J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 4 DPMQ: $179.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Comtan