ALLOPURINOL

allopurinol 100 mg tablet, 200

ALLOPURINOL (13358C)

allopurinol 100 mg tablet, 200
13358C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 400 # of repeats: 2 DPMQ: $23.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
Progout 100
Progout Viatris
Zyloprim
*Additional charge for this brand is $11.24
 DPMQ: $34.76 Max safety net: $25.00 General Patient Charge: $36.24