DOXYCYCLINE
Body System:
Manner of administration:Oral
Restriction
Indication: Urethritis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 21 | # of repeats: 0 | DPMQ: $22.18 | Max safety net: $23.72 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction
Indication: Bronchiectasis
Restriction
Indication: Chronic bronchitis
Restriction
Indication: Severe acne
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 50 | # of repeats: 2 | DPMQ: $20.18 | Max safety net: $21.72 | General Patient Charge: $24.51 |
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Body System:
Manner of administration:Oral
Restriction
Indication: Pelvic inflammatory disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 28 | # of repeats: 0 | DPMQ: $25.32 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 7 | # of repeats: 1 | DPMQ: $17.10 | Max safety net: $18.64 | General Patient Charge: $21.43 |
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Body System:
Manner of administration:Oral
Restriction
Indication: Bronchiectasis
Restriction
Indication: Chronic bronchitis
Restriction
Indication: Severe acne
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 25 | # of repeats: 5 | DPMQ: $17.27 | Max safety net: $18.81 | General Patient Charge: $21.60 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction
Indication: Urethritis
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 21 | # of repeats: 0 | DPMQ: $22.59 | Max safety net: $24.13 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 7 | # of repeats: 0 | DPMQ: $17.10 | Max safety net: $18.64 | General Patient Charge: $21.43 |
| Available brands | |||||
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