FLUTICASONE PROPIONATE

FLUTICASONE PROPIONATE (14487L)

fluticasone propionate 50 microgram/actuation inhalation, 120 actuations
14487L
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

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
Available brands
Axotide Junior
Flixotide Junior
*Additional charge for this brand is $8.00
 DPMQ: $36.62 Max safety net: $25.00 General Patient Charge: $33.00

FLUTICASONE PROPIONATE (8516F)

fluticasone propionate 50 microgram/actuation inhalation, 120 actuations
8516F
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

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
Available brands
Axotide Junior
Flixotide Junior
*Additional charge for this brand is $4.00
 DPMQ: $25.20 Max safety net: $22.68 General Patient Charge: $29.00