AMBRISENTAN
ambrisentan 10 mg tablet, 30
AMBRISENTAN (9649W)
9649W
Body System:
Manner of administration:Oral
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 1 (new patients)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 2 (change)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 30 | # of repeats: 5 | DPMQ: $1,268.63 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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