PRAMIPEXOLE

pramipexole dihydrochloride monohydrate 250 microgram tablet, 100

PRAMIPEXOLE (14329E)

pramipexole dihydrochloride monohydrate 250 microgram tablet, 100
14329E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Parkinson disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $43.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Pramipexole
Simipex 0.25
Simpral
Sifrol
*Additional charge for this brand is $7.54
 DPMQ: $50.90 Max safety net: $25.00 General Patient Charge: $32.54