LANSOPRAZOLE

lansoprazole 15 mg orally disintegrating tablet, 28

LANSOPRAZOLE (9331D)

lansoprazole 15 mg orally disintegrating tablet, 28
9331D
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Gastro-oesophageal reflux disease

Restriction

Indication: Scleroderma oesophagus
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $18.02 Max safety net: $19.56 General Patient Charge: $22.35
Available brands
APO-Lansoprazole ODT
Lansoprazole ODT GH
Zopral ODT
Zoton FasTabs
*Additional charge for this brand is $4.57
 DPMQ: $22.59 Max safety net: $19.56 General Patient Charge: $26.92