MESALAZINE

mesalazine 1 g suppository, 28

MESALAZINE (12198B)

mesalazine 1 g suppository, 28
12198B
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Mild to moderate ulcerative proctitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $83.46 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pentasa