Source	General Schedule
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14786FMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations (PI, CMI)	8	24	0	$7,228.30	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14787GMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 actuations (PI, CMI)	8	8	0	$2,407.66	$25.00	$25.00
	Available brands
	Spravato

Source	General Schedule
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14794PMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations (PI, CMI)	4	8	5	$2,494.66	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14798WMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations (PI, CMI)	4	12	5	$3,584.30	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14811MMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 actuations (PI, CMI)	4	4	5	$1,231.02	$25.00	$25.00
	Available brands
	Spravato

Source	General Schedule
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14812NMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 actuations (PI, CMI)	4	4	5	$1,278.18	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14813PMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations (PI, CMI)	8	16	0	$4,706.56	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14814QMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations (PI, CMI)	4	8	5	$2,407.66	$25.00	$25.00
	Available brands
	Spravato

Source	General Schedule
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14815RMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations (PI, CMI)	8	16	0	$4,875.02	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14816TMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 actuations (PI, CMI)	8	8	0	$2,353.28	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14821CMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations (PI, CMI)	4	12	5	$3,529.92	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14822DMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 actuations (PI, CMI)	4	4	5	$1,176.64	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14823EMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations (PI, CMI)	8	24	0	$7,114.22	$25.00	$25.00
	Available brands
	Spravato

Source	General Schedule
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14830MMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations (PI, CMI)	4	12	5	$3,671.30	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14831NMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations (PI, CMI)	8	16	0	$4,760.94	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14835TMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 3 x 2 actuations (PI, CMI)	8	24	0	$7,059.84	$25.00	$25.00
	Available brands
	Spravato

Source	General Schedule
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14836WMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 actuations (PI, CMI)	8	8	0	$2,521.74	$25.00	$25.00
	Available brands
	Spravato

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > PSYCHOANALEPTICS > ANTIDEPRESSANTS

Note

Authority Required

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
14837XMP	ESKETAMINE esketamine 28 mg/2 actuations nasal spray, 2 x 2 actuations (PI, CMI)	4	8	5	$2,353.28	$25.00	$25.00
	Available brands
	Spravato