CLOZAPINE

CLOZAPINE (10289M)

clozapine 25 mg tablet, 100
10289M
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4998)

Indication: Schizophrenia
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 0 DPMQ: $68.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clopine 25
Clozaril 25
Clozitor

CLOZAPINE (5628F)

clozapine 25 mg tablet, 100
5628F
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5015)

Indication: Schizophrenia
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 0 DPMQ: $55.50 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clopine 25
Clozaril 25
Clozitor

CLOZAPINE (6101D)

clozapine 25 mg tablet, 100
6101D
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9490)

Indication: Schizophrenia
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 0 DPMQ: $68.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clopine 25
Clozaril 25
Clozitor