GLECAPREVIR + PIBRENTASVIR

glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84

GLECAPREVIR + PIBRENTASVIR (11333L)

glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84
11333L
Manner of administration:Oral
Public
S100 HSD Public
Authority Required

Restriction

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 84 # of repeats: 3 DPMQ: $16,846.67 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Maviret