ESCITALOPRAM

10181W

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Major depressive disorders

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 1	Max qty units: 1	# of repeats: 5	DPMQ: $39.55	Max safety net: $25.00	General Patient Charge: $25.00
Available brands
Lexapro

14349F

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Major depressive disorders

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 56	# of repeats: 2	DPMQ: $19.84	Max safety net: $21.38	General Patient Charge: $24.17
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
Cilopam-S
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 10
LoxaLate
Lexapro *Additional charge for this brand is $27.30			DPMQ: $47.14	Max safety net: $21.38	General Patient Charge: $51.47

14415Q

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Major depressive disorders

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 56	# of repeats: 2	DPMQ: $19.84	Max safety net: $21.38	General Patient Charge: $24.17
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
Cilopam-S
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 20
LoxaLate
Lexapro *Additional charge for this brand is $27.96			DPMQ: $47.80	Max safety net: $21.38	General Patient Charge: $52.13

14416R

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 56	# of repeats: 2	DPMQ: $19.84	Max safety net: $21.38	General Patient Charge: $24.17
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 20
LoxaLate
Lexapro *Additional charge for this brand is $27.96			DPMQ: $47.80	Max safety net: $21.38	General Patient Charge: $52.13

14519E

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 56	# of repeats: 2	DPMQ: $19.84	Max safety net: $21.38	General Patient Charge: $24.17
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 10
LoxaLate
Lexapro *Additional charge for this brand is $27.30			DPMQ: $47.14	Max safety net: $21.38	General Patient Charge: $51.47

14546N

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Major depressive disorders

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 2	# of repeats: 2	DPMQ: $64.74	Max safety net: $25.00	General Patient Charge: $25.00
Available brands
Lexapro

8700X

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Major depressive disorders

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: $17.10	Max safety net: $18.64	General Patient Charge: $21.43
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
Cilopam-S
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 10
LoxaLate
Lexapro *Additional charge for this brand is $13.65			DPMQ: $30.75	Max safety net: $18.64	General Patient Charge: $35.08

8701Y

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Major depressive disorders

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: $17.10	Max safety net: $18.64	General Patient Charge: $21.43
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
Cilopam-S
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 20
LoxaLate
Lexapro *Additional charge for this brand is $13.98			DPMQ: $31.08	Max safety net: $18.64	General Patient Charge: $35.41

9432K

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

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: $17.10	Max safety net: $18.64	General Patient Charge: $21.43
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 10
LoxaLate
Lexapro *Additional charge for this brand is $13.65			DPMQ: $30.75	Max safety net: $18.64	General Patient Charge: $35.08

9433L

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe generalised anxiety disorder (GAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

Restriction

Indication: Moderate to severe social anxiety disorder (social phobia, SAD)

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: $17.10	Max safety net: $18.64	General Patient Charge: $21.43
Available brands
APO-Escitalopram
APX-Escitalopram
Blooms Escitalopram
ESCIT
ESCITALOPRAM-WGR
Escitalopram GH
Escitalopram Sandoz
Lexam 20
LoxaLate
Lexapro *Additional charge for this brand is $13.98			DPMQ: $31.08	Max safety net: $18.64	General Patient Charge: $35.41

ESCITALOPRAM (10181W)

Restriction

Restriction

Restriction

Restriction

Restriction

ESCITALOPRAM (14349F)

Restriction

ESCITALOPRAM (14415Q)

Restriction

ESCITALOPRAM (14416R)

Restriction

Restriction

Restriction

Restriction

ESCITALOPRAM (14519E)

Restriction

Restriction

Restriction

Restriction

ESCITALOPRAM (14546N)

Restriction

Restriction

Restriction

Restriction

Restriction

ESCITALOPRAM (8700X)

Restriction

ESCITALOPRAM (8701Y)

Restriction

ESCITALOPRAM (9432K)

Restriction

Restriction

Restriction

Restriction

ESCITALOPRAM (9433L)

Restriction

Restriction

Restriction

Restriction