BISACODYL

bisacodyl 10 mg suppository, 10

BISACODYL (1260H)

bisacodyl 10 mg suppository, 10
1260H
Body System:
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $26.43 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Petrus Bisacodyl Suppositories
Dulcolax
*Additional charge for this brand is $1.29
 DPMQ: $27.72 Max safety net: $25.00 General Patient Charge: $26.29