FAMCICLOVIR
Manner of administration:Oral
Restriction (Streamlined authority code: 5954)
Indication: Recurrent moderate to severe genital herpes
Treatment phase: Episodic treatment or suppressive therapy
Restriction (Streamlined authority code: 5947)
Indication: Recurrent moderate to severe oral or labial herpes
Treatment phase: Episodic treatment
Restriction (Streamlined authority code: 5948)
Indication: Recurrent moderate to severe oral or labial herpes
Treatment phase: Suppressive therapy
Restriction (Streamlined authority code: 5949)
Indication: Recurrent moderate to severe oral or labial herpes
Treatment phase: Suppressive therapy
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: $66.06 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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