ADAPALENE + BENZOYL PEROXIDE

ADAPALENE + BENZOYL PEROXIDE (13363H)

adapalene 0.1% + benzoyl peroxide 2.5% gel, 30 g
13363H
Body System:
Manner of administration:Application
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne vulgaris
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: 3 DPMQ: $47.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Epiduo

ADAPALENE + BENZOYL PEROXIDE (8954G)

adapalene 0.1% + benzoyl peroxide 2.5% gel, 30 g
8954G
Body System:
Manner of administration:Application
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne vulgaris
Treatment phase: Acute 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: 1 # of repeats: 1 DPMQ: $30.55 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Epiduo

ADAPALENE + BENZOYL PEROXIDE (8955H)

adapalene 0.1% + benzoyl peroxide 2.5% gel, 30 g
8955H
Body System:
Manner of administration:Application
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne vulgaris
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: 3 DPMQ: $30.55 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Epiduo