DESMOPRESSIN

DESMOPRESSIN (13889B)

desmopressin acetate 200 microgram tablet, 30
13889B
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15012)

Indication: Cranial diabetes insipidus
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 180 # of repeats: 5 DPMQ: $218.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin

DESMOPRESSIN (13890C)

desmopressin 240 microgram sublingual wafer, 30
13890C
Body System:
Manner of administration:Sublingual
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14945)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 15025)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $140.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin Melt

DESMOPRESSIN (13945Y)

desmopressin acetate 200 microgram tablet, 30
13945Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14972)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 14842)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $80.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin

DESMOPRESSIN (14004C)

desmopressin 120 microgram sublingual wafer, 30
14004C
Body System:
Manner of administration:Sublingual
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14972)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 14842)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $87.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin Melt

DESMOPRESSIN (8662X)

desmopressin acetate 200 microgram tablet, 30
8662X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5266)

Indication: Cranial diabetes insipidus
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 90 # of repeats: 5 DPMQ: $113.43 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin

DESMOPRESSIN (8663Y)

desmopressin acetate 200 microgram tablet, 30
8663Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5413)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 5295)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $47.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin

DESMOPRESSIN (8711L)

desmopressin acetate 10 microgram/actuation nasal spray, 60 actuations
8711L
Body System:
Manner of administration:Nasal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5266)

Indication: Cranial diabetes insipidus
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $102.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin Nasal Spray

DESMOPRESSIN (8712M)

desmopressin acetate 10 microgram/actuation nasal spray, 60 actuations
8712M
Body System:
Manner of administration:Nasal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5342)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 5267)

Indication: Primary nocturnal enuresis
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: $58.19 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin Nasal Spray

DESMOPRESSIN (8975J)

desmopressin 240 microgram sublingual wafer, 30
8975J
Body System:
Manner of administration:Sublingual
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5412)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 5226)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $76.69 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin Melt

DESMOPRESSIN (9398P)

desmopressin 120 microgram sublingual wafer, 30
9398P
Body System:
Manner of administration:Sublingual
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5412)

Indication: Primary nocturnal enuresis

Restriction (Streamlined authority code: 5226)

Indication: Primary nocturnal enuresis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $50.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Minirin Melt