EDARAVONE

edaravone 30 mg/20 mL injection, 10 x 20 mL ampoules
Manner of administration:Injection
S100 HSD Community Access
Authority Required

Restriction

Indication: Amyotrophic lateral sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 20 # of repeats: 2 DPMQ: $4,583.24 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Radicava
edaravone 30 mg/20 mL injection, 10 x 20 mL ampoules
Manner of administration:Injection
S100 HSD Community Access
Authority Required

Restriction

Indication: Amyotrophic lateral sclerosis
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2.8000000000000003 Max qty units: 28 # of repeats: 0 DPMQ: $6,396.85 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Radicava