Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12830GMPMWNP	LEVOTHYROXINE levothyroxine sodium 125 microgram tablet, 200 (PI, CMI)	1	200	1	$25.27	$26.75	$30.20
	Available brands
	Eltroxin

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12960DMPMWNP	LEVOTHYROXINE levothyroxine sodium 75 microgram tablet, 2 x 100 (PI, CMI)	1	200	1	$22.57	$24.05	$27.50
	Available brands
	LEVOXINEa
	Thyroxa

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12968MMPMWNP	LEVOTHYROXINE levothyroxine sodium 100 microgram tablet, 2 x 100 (PI, CMI)	1	200	1	$22.74	$24.22	$27.67
	Available brands
	LEVOXINEa
	Thyroxa

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12969NMPMWNP	LEVOTHYROXINE levothyroxine sodium 50 microgram tablet, 2 x 100 (PI, CMI)	1	200	1	$22.42	$23.90	$27.35
	Available brands
	LEVOXINEa
	Thyroxa

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12970PMPMWNP	LEVOTHYROXINE levothyroxine sodium 200 microgram tablet, 2 x 100 (PI, CMI)	1	200	1	$24.28	$25.76	$29.21
	Available brands
	LEVOXINEa
	Thyroxa

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2173JMPMWNP	LEVOTHYROXINE levothyroxine sodium 200 microgram tablet, 200 (PI, CMI)	1	200	1	$24.28	$25.76	$29.21
	Available brands
	APO-Levothyroxinea
	Eltroxinb
	Eutroxsiga
	Levothoxb
	Levothyroxine Lupa
	Levothyroxine Sandoza
	Oroxinea * Additional charge for this brand is $1.12B	1	200	1	$25.40	$25.76	$30.33

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2174KMPMWNP	LEVOTHYROXINE levothyroxine sodium 50 microgram tablet, 200 (PI, CMI)	1	200	1	$22.42	$23.90	$27.35
	Available brands
	APO-Levothyroxinea
	Eltroxinb
	Eutroxsiga
	Levothoxb
	Levothyroxine Lupa
	Levothyroxine Sandoza
	Oroxinea * Additional charge for this brand is $1.12B	1	200	1	$23.54	$23.90	$28.47

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2175LMPMWNP	LEVOTHYROXINE levothyroxine sodium 100 microgram tablet, 200 (PI, CMI)	1	200	1	$22.74	$24.22	$27.67
	Available brands
	APO-Levothyroxinea
	Eltroxinb
	Eutroxsiga
	Levothoxb
	Levothyroxine Lupa
	Levothyroxine Sandoza
	Oroxinea * Additional charge for this brand is $1.11B	1	200	1	$23.85	$24.22	$28.78

Source	General Schedule
Body System	SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS > THYROID THERAPY > THYROID PREPARATIONS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
9287TMPMWNP	LEVOTHYROXINE levothyroxine sodium 75 microgram tablet, 200 (PI, CMI)	1	200	1	$22.57	$24.05	$27.50
	Available brands
	APO-Levothyroxinea
	Eltroxinb
	Eutroxsiga
	Levothoxb
	Levothyroxine Lupa
	Levothyroxine Sandoza
	Oroxinea * Additional charge for this brand is $1.13B	1	200	1	$23.70	$24.05	$28.63