CLOZAPINE

CLOZAPINE (10341G)

clozapine 50 mg/mL oral liquid, 100 mL
10341G
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: 1 Max qty units: 1 # of repeats: 0 DPMQ: $149.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clopine Suspension

CLOZAPINE (11415T)

clozapine 50 mg/mL oral liquid, 100 mL
11415T
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: 1 Max qty units: 1 # of repeats: 0 DPMQ: $149.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Versacloz

CLOZAPINE (11422E)

clozapine 50 mg/mL oral liquid, 100 mL
11422E
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: 1 Max qty units: 1 # of repeats: 0 DPMQ: $149.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Versacloz

CLOZAPINE (11433R)

clozapine 50 mg/mL oral liquid, 100 mL
11433R
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: 1 Max qty units: 1 # of repeats: 0 DPMQ: $135.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Versacloz

CLOZAPINE (5630H)

clozapine 50 mg/mL oral liquid, 100 mL
5630H
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: 1 Max qty units: 1 # of repeats: 0 DPMQ: $135.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clopine Suspension

CLOZAPINE (9632Y)

clozapine 50 mg/mL oral liquid, 100 mL
9632Y
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: 1 Max qty units: 1 # of repeats: 0 DPMQ: $149.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clopine Suspension