TRAMADOL

TRAMADOL (5232J)

tramadol hydrochloride 50 mg capsule, 20
5232J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 20 # of repeats: 0 DPMQ: $16.70 Max safety net: $18.18 General Patient Charge: $20.97
Available brands
APO-Tramadol
TRAMADOL-WGR
Tramadol Sandoz
Tramedo
Zydol
Tramal
*Additional charge for this brand is $2.25
 DPMQ: $18.95 Max safety net: $18.18 General Patient Charge: $23.22