RILUZOLE
Body System:
Manner of administration:Oral
Restriction
Indication: Amyotrophic lateral sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 5 | DPMQ: $209.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction
Indication: Amyotrophic lateral sclerosis
Treatment phase: Initial treatment
Restriction
Indication: Amyotrophic lateral sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $109.53 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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