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
13489YMPNP	DABIGATRAN dabigatran etexilate 150 mg capsule, 60 (PI, CMI)	2	120	5	$84.64	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $17.86B	2	120	5	$102.50	$31.60	$49.46

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	$49.21	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	Dabigatran Viatrisa
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $8.93B	1	60	5	$58.14	$31.60	$40.53