Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
5857GMP	ONDANSETRON ondansetron 4 mg orally disintegrating tablet, 4 (PI, CMI)	1	4	0	$3.50	$4.95	$4.95
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
5858HMP	ONDANSETRON ondansetron 8 mg orally disintegrating tablet, 4 (PI, CMI)	1	4	0	$4.33	$5.78	$5.78
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
5967CMP	ONDANSETRON ondansetron 4 mg tablet, 4 (PI, CMI)	1	4	0	$3.50	$4.95	$4.95
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 4a

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
5968DMP	ONDANSETRON ondansetron 8 mg tablet, 4 (PI, CMI)	1	4	0	$4.33	$5.78	$5.78
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 8a