RIZATRIPTAN

RIZATRIPTAN (9313E)

rizatriptan 10 mg wafer, 2
9313E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Migraine attack
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 4 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Maxalt
*Additional charge for this brand is $4.80
 DPMQ: $27.20 Max safety net: $23.88 General Patient Charge: $29.80
Rizatriptan Wafers-10mg
*Additional charge for this brand is $3.60
 DPMQ: $26.00 Max safety net: $23.88 General Patient Charge: $28.60