Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14324XMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 375 microgram modified release tablet, 30 (PI, CMI)	2	60	5	$29.32	$30.80	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14325YMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 4.5 mg modified release tablet, 30 (PI, CMI)	2	60	5	$218.66	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14329EMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 250 microgram tablet, 100 (PI, CMI)	2	200	5	$43.36	$31.60	$31.60
	Available brands
	APO-Pramipexolea
	Simipex 0.25a
	Simprala
	Sifrola * Additional charge for this brand is $7.54B	2	200	5	$50.90	$31.60	$39.14

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14360TMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 1.5 mg modified release tablet, 30 (PI, CMI)	2	60	5	$74.88	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14459BMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 750 microgram modified release tablet, 30 (PI, CMI)	2	60	5	$44.34	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14460CMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 3 mg modified release tablet, 30 (PI, CMI)	2	60	5	$148.72	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14461DMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 3.75 mg modified release tablet, 30 (PI, CMI)	2	60	5	$180.76	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14532WMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 1 mg tablet, 100 (PI, CMI)	2	200	5	$144.26	$31.60	$31.60
	Available brands
	APO-Pramipexolea
	Sifrola
	Simipex 1a
	Simprala

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
14556DMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 2.25 mg modified release tablet, 30 (PI, CMI)	2	60	5	$105.40	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
3418XMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 375 microgram modified release tablet, 30 (PI, CMI)	1	30	5	$21.55	$23.03	$26.48
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
3419YMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 750 microgram modified release tablet, 30 (PI, CMI)	1	30	5	$29.06	$30.54	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
3420BMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 1.5 mg modified release tablet, 30 (PI, CMI)	1	30	5	$44.33	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
3421CMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 3 mg modified release tablet, 30 (PI, CMI)	1	30	5	$80.42	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
3422DMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 4.5 mg modified release tablet, 30 (PI, CMI)	1	30	5	$113.73	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
5143QMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 2.25 mg modified release tablet, 30 (PI, CMI)	1	30	5	$59.59	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
5145TMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 3.75 mg modified release tablet, 30 (PI, CMI)	1	30	5	$95.68	$31.60	$31.60
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
9151PMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 125 microgram tablet, 30 (PI, CMI)	1	30	0	$17.24	$18.72	$22.17
	Available brands
	APO-Pramipexolea
	Sifrola
	Simipex 0.125a
	Simprala

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
9152QMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 250 microgram tablet, 100 (PI, CMI)	1	100	5	$28.57	$30.05	$31.60
	Available brands
	APO-Pramipexolea
	Simipex 0.25a
	Simprala
	Sifrola * Additional charge for this brand is $3.77B	1	100	5	$32.34	$30.05	$35.37

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
9153RMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 1 mg tablet, 100 (PI, CMI)	1	100	5	$78.30	$31.60	$31.60
	Available brands
	APO-Pramipexolea
	Sifrola
	Simipex 1a
	Simprala

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
9393JMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 125 microgram tablet, 30 (PI, CMI)	1	30	2	$17.24	$18.72	$22.17
	Available brands
	APO-Pramipexolea
	Sifrola
	Simipex 0.125a
	Simprala

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

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
9394KMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 250 microgram tablet, 100 (PI, CMI)	1	100	2	$28.57	$30.05	$31.60
	Available brands
	APO-Pramipexolea
	Simipex 0.25a
	Simprala
	Sifrola * Additional charge for this brand is $3.77B	1	100	2	$32.34	$30.05	$35.37