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	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
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
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	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