BUPRENORPHINE

BUPRENORPHINE (13296T)

buprenorphine 24 mg/0.48 mL modified release injection, 0.48 mL syringe
13296T
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16051)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Weekly

BUPRENORPHINE (13297W)

buprenorphine 16 mg/0.32 mL modified release injection, 0.32 mL syringe
13297W
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16051)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Weekly

BUPRENORPHINE (13298X)

buprenorphine 64 mg/0.18 mL modified release injection, 0.18 mL syringe
13298X
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16015)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Monthly

BUPRENORPHINE (13302D)

buprenorphine 128 mg/0.36 mL modified release injection, 0.36 mL syringe
13302D
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16015)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Monthly

BUPRENORPHINE (13303E)

buprenorphine 160 mg/0.45 mL modified release injection, 0.45 mL syringe
13303E
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16015)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Monthly

BUPRENORPHINE (13309L)

buprenorphine 96 mg/0.27 mL modified release injection, 0.27 mL syringe
13309L
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16015)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Monthly

BUPRENORPHINE (13314R)

buprenorphine 32 mg/0.64 mL modified release injection, 0.64 mL syringe
13314R
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16051)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Weekly

BUPRENORPHINE (13328L)

buprenorphine 8 mg/0.16 mL modified release injection, 0.16 mL syringe
13328L
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16051)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $379.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Buvidal Weekly