ISOTRETINOIN

ISOTRETINOIN (11621P)

isotretinoin 20 mg capsule, 30
11621P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17268)

Indication: Severe cystic acne
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: 3 DPMQ: $40.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Isotretinoin Dr.Reddy's
Roaccutane

ISOTRETINOIN (11716P)

isotretinoin 5 mg capsule, 60
11716P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17268)

Indication: Severe cystic acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 3 DPMQ: $25.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Oratane

ISOTRETINOIN (11921K)

isotretinoin 30 mg capsule, 60
11921K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17268)

Indication: Severe cystic acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 3 DPMQ: $63.75 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Oratane

ISOTRETINOIN (2549E)

isotretinoin 40 mg capsule, 30
2549E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17268)

Indication: Severe cystic acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 3 DPMQ: $47.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dermatane
Oratane

ISOTRETINOIN (2591J)

isotretinoin 10 mg capsule, 60
2591J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17268)

Indication: Severe cystic acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 3 DPMQ: $30.87 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Isotretinoin
Dermatane
ISOTRETINOIN-WGR
Isotretinoin GX
Isotretinoin Lupin
Oratane

ISOTRETINOIN (2592K)

isotretinoin 20 mg capsule, 60
2592K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17268)

Indication: Severe cystic acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 3 DPMQ: $40.43 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Isotretinoin
Dermatane
ISOTRETINOIN-WGR
Isotretinoin Dr.Reddy's
Isotretinoin GX
Isotretinoin Lupin
Oratane
Pharmacor Isotretinoin