LAMIVUDINE

LAMIVUDINE (10311Q)

lamivudine 300 mg tablet, 30
10311Q
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4512)

Indication: HIV infection
Treatment phase: Initial

Restriction (Streamlined authority code: 4454)

Indication: HIV infection
Treatment phase: Continuing
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $105.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
3TC
Lamivudine Alphapharm
Lamivudine Viatris

LAMIVUDINE (10315X)

lamivudine 100 mg tablet, 28
10315X
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4993)

Indication: Chronic hepatitis B infection

Restriction (Streamlined authority code: 5036)

Indication: Chronic hepatitis B infection
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: 5 DPMQ: $62.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zetlam
Zeffix
*Additional charge for this brand is $2.46
 DPMQ: $64.60 Max safety net: $25.00 General Patient Charge: $27.46

LAMIVUDINE (10320E)

lamivudine 10 mg/mL oral liquid, 240 mL
10320E
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4512)

Indication: HIV infection
Treatment phase: Initial

Restriction (Streamlined authority code: 4454)

Indication: HIV infection
Treatment phase: Continuing
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 8 # of repeats: 5 DPMQ: $495.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
3TC

LAMIVUDINE (10348P)

lamivudine 150 mg tablet, 60
10348P
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4512)

Indication: HIV infection
Treatment phase: Initial

Restriction (Streamlined authority code: 4454)

Indication: HIV infection
Treatment phase: Continuing
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $105.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
3TC
Lamivudine Viatris