Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
3418XMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 375 microgram modified release tablet, 30 (PI, CMI)	1	30	5	$21.55	$23.03	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
3419YMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 750 microgram modified release tablet, 30 (PI, CMI)	1	30	5	$29.06	$25.00	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
3420BMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 1.5 mg modified release tablet, 30 (PI, CMI)	1	30	5	$44.33	$25.00	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
3421CMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 3 mg modified release tablet, 30 (PI, CMI)	1	30	5	$80.42	$25.00	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
3422DMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 4.5 mg modified release tablet, 30 (PI, CMI)	1	30	5	$113.73	$25.00	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
5143QMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 2.25 mg modified release tablet, 30 (PI, CMI)	1	30	5	$59.59	$25.00	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

Caution

Note

Restricted Benefit

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
5145TMPNP	PRAMIPEXOLE pramipexole dihydrochloride monohydrate 3.75 mg modified release tablet, 30 (PI, CMI)	1	30	5	$95.68	$25.00	$25.00
	Available brands
	SIMIPEX XRa
	Sifrol ERa