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	$7227.80	$31.60	$31.60
	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	$2407.32	$31.60	$31.60
	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	$2494.20	$31.60	$31.60
	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	$3583.96	$31.60	$31.60
	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	$1230.68	$31.60	$31.60
	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	$1277.72	$31.60	$31.60
	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	$4706.56	$31.60	$31.60
	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	$2407.32	$31.60	$31.60
	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	$4874.52	$31.60	$31.60
	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	$2353.28	$31.60	$31.60
	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	$3529.92	$31.60	$31.60
	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	$1176.64	$31.60	$31.60
	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	$7113.88	$31.60	$31.60
	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	$3670.84	$31.60	$31.60
	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	$4760.60	$31.60	$31.60
	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	$7059.84	$31.60	$31.60
	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	$2521.24	$31.60	$31.60
	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	$2353.28	$31.60	$31.60
	Available brands
	Spravato