BISACODYL

bisacodyl 10 mg suppository, 10

BISACODYL (14447J)

bisacodyl 10 mg suppository, 10
14447J
Body System:
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 5 DPMQ: $39.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Petrus Bisacodyl Suppositories
Dulcolax
*Additional charge for this brand is $2.58
 DPMQ: $41.64 Max safety net: $25.00 General Patient Charge: $27.58