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	$72.32	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $14.74B	2	120	5	$87.06	$25.00	$39.74

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	$72.76	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $14.78B	2	120	5	$87.54	$25.00	$39.78

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	$43.27	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $7.39B	1	60	5	$50.66	$25.00	$32.39

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	$43.05	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $7.37B	1	60	5	$50.42	$25.00	$32.37

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	$23.62	$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	$43.27	$25.00	$25.00
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $7.39B	1	60	0	$50.66	$25.00	$32.39

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	$23.62	$25.00	$25.00
	Available brands
	Pradaxa