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
2160QMPNP	RIVAROXABAN rivaroxaban 15 mg tablet, 42 (PI, CMI)	1	42	0	$66.33	$31.60	$31.60
	Available brands
	ARX-Rivaroxaban 15a
	RIVAXIBa
	Rivaroxaban Lupina
	Rivaroxaban Sandoza
	Rivaroxaban-Tevaa
	Rivoxaa
	Xareltoa

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
2268JMPNP	RIVAROXABAN rivaroxaban 20 mg tablet, 28 (PI, CMI)	1	28	5	$48.27	$31.60	$31.60
	Available brands
	ARX-Rivaroxaban 20a
	RIVAXIBa
	Rivaroxaban Dr.Reddy'sa
	Rivaroxaban Lupina
	Rivaroxaban Sandoza
	Rivaroxaban-Tevaa
	Rivoxaa
	Xareltoa
	iXarolaa

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
2691PMPNP	RIVAROXABAN rivaroxaban 15 mg tablet, 28 (PI, CMI)	1	28	5	$48.71	$31.60	$31.60
	Available brands
	ARX-Rivaroxaban 15a
	RIVAXIBa
	Rivaroxaban Dr.Reddy'sa
	Rivaroxaban Lupina
	Rivaroxaban Sandoza
	Rivaroxaban-Tevaa
	Rivoxaa
	Xareltoa
	iXarolaa

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
2735YMPNP	APIXABAN apixaban 5 mg tablet, 60 (PI, CMI)	1	60	5	$67.65	$31.60	$31.60
	Available brands
	Eliquis

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
2744KMPNP	APIXABAN apixaban 2.5 mg tablet, 60 (PI, CMI)	1	60	5	$69.13	$31.60	$31.60
	Available brands
	Eliquis

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	$49.14	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	5	$58.07	$31.60	$40.53

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	$48.88	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	5	$57.81	$31.60	$40.53

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
5054BMPNP	APIXABAN apixaban 2.5 mg tablet, 30 (PI, CMI)	1	30	0	$41.30	$31.60	$31.60
	Available brands
	Eliquis

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
5061JMPNP	APIXABAN apixaban 2.5 mg tablet, 60 (PI, CMI)	1	60	0	$69.13	$31.60	$31.60
	Available brands
	Eliquis

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
5500LMPNP	APIXABAN apixaban 2.5 mg tablet, 20 (PI, CMI)	1	20	0	$32.02	$31.60	$31.60
	Available brands
	Eliquis

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	$35.69	$31.60	$31.60
	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
9319LMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 10 (PI, CMI)	2	20	1	$25.37	$26.82	$30.27
	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	$80.10	$31.60	$31.60
	Available brands
	ARX-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	$49.14	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	0	$58.07	$31.60	$40.53

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	$35.69	$31.60	$31.60
	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
9323QMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 10 (PI, CMI)	2	20	0	$25.37	$26.82	$30.27
	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
9466FMPNP	RIVAROXABAN rivaroxaban 10 mg tablet, 15 (PI, CMI)	1	15	1	$33.48	$31.60	$31.60
	Available brands
	ARX-Rivaroxaban 10a
	Xareltoa

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
9467GMPNP	RIVAROXABAN rivaroxaban 10 mg tablet, 30 (PI, CMI)	1	30	0	$53.50	$31.60	$31.60
	Available brands
	ARX-Rivaroxaban 10a
	RIVAXIBa
	Rivaroxaban Dr.Reddy'sa
	Rivaroxaban Lupina
	Rivaroxaban Sandoza
	Rivaroxaban-Tevaa
	Rivoxaa
	Xareltoa
	iXarolaa

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
9469JMPNP	RIVAROXABAN rivaroxaban 10 mg tablet, 15 (PI, CMI)	1	15	0	$33.48	$31.60	$31.60
	Available brands
	ARX-Rivaroxaban 10a
	Xareltoa