Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
13489YMPNP	DABIGATRAN dabigatran etexilate 150 mg capsule, 60 (PI, CMI)	2	120	5	$84.64	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $17.86B	2	120	5	$102.50	$25.00	$42.86

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
13523RMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 60 (PI, CMI)	2	120	5	$85.16	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $17.86B	2	120	5	$103.02	$25.00	$42.86

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
2753XMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 60 (PI, CMI)	1	60	5	$49.47	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	5	$58.40	$25.00	$33.93

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
2769RMPNP	DABIGATRAN dabigatran etexilate 150 mg capsule, 60 (PI, CMI)	1	60	5	$49.21	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	5	$58.14	$25.00	$33.93

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
9318KMPNP	DABIGATRAN dabigatran etexilate 75 mg capsule, 10 (PI, CMI)	2	20	1	$32.08	$25.00	$25.00
	Available brands
	PHARMACOR DABIGATRAN

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
9319LMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 10 (PI, CMI)	2	20	1	$25.70	$25.00	$25.00
	Available brands
	Pradaxa

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
9320MMPNP	DABIGATRAN dabigatran etexilate 75 mg capsule, 60 (PI, CMI)	1	60	0	$68.63	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
9321NMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 60 (PI, CMI)	1	60	0	$49.47	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	0	$58.40	$25.00	$33.93

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
9322PMPNP	DABIGATRAN dabigatran etexilate 75 mg capsule, 10 (PI, CMI)	2	20	0	$32.08	$25.00	$25.00
	Available brands
	PHARMACOR DABIGATRAN

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

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
9323QMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 10 (PI, CMI)	2	20	0	$25.70	$25.00	$25.00
	Available brands
	Pradaxa