PRAMIPEXOLE

pramipexole dihydrochloride monohydrate 250 microgram tablet, 100

PRAMIPEXOLE (9394K)

pramipexole dihydrochloride monohydrate 250 microgram tablet, 100
9394K
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Primary severe restless legs syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 2 DPMQ: $28.57 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Pramipexole
Simipex 0.25
Simpral
Sifrol
*Additional charge for this brand is $3.77
 DPMQ: $32.34 Max safety net: $25.00 General Patient Charge: $28.77