OXYCODONE

oxycodone hydrochloride 5 mg tablet, 20

OXYCODONE (15424T)

oxycodone hydrochloride 5 mg tablet, 20
15424T
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 0.5 Max qty units: 10 # of repeats: 0 DPMQ: $23.33 Max safety net: $24.87 General Patient Charge: $25.00
Available brands
Mayne Pharma Oxycodone IR
Oxycodone Viatris
Oxyndone
ENDONE
*Additional charge for this brand is $1.24
 DPMQ: $24.57 Max safety net: $24.87 General Patient Charge: $26.24