TRAMADOL

TRAMADOL (5232J)

tramadol hydrochloride 50 mg capsule, 20
5232J
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: 1 Max qty units: 20 # of repeats: 0 DPMQ: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Tramadol
TRAMADOL-WGR
Tramadol Sandoz
Tramedo
Zydol
Tramal
*Additional charge for this brand is $2.25
 DPMQ: $19.35 Max safety net: $18.64 General Patient Charge: $23.68