SILDENAFIL
Body System:
Manner of administration:Oral
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 1 - combination therapy (dual or triple therapy, excluding selexipag) in an
untreated patient
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 2 - starting combination therapy (dual or triple therapy, excluding selexipag)
in a treated patient where a diagnosis of pulmonary arterial hypertension is established
through a prior PBS authority application
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 3 - changing to this drug in combination therapy (dual or triple therapy)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Continuing treatment of combination therapy (dual or triple therapy, excluding selexipag)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Triple therapy - Initial treatment or continuing treatment of triple combination therapy
(including dual therapy in lieu of triple therapy) that includes selexipag
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 90 | # of repeats: 5 | DPMQ: $108.69 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 1 - combination therapy (dual or triple therapy, excluding selexipag) in an
untreated patient
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 2 - starting combination therapy (dual or triple therapy, excluding selexipag)
in a treated patient where a diagnosis of pulmonary arterial hypertension is established
through a prior PBS authority application
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 3 - changing to this drug in combination therapy (dual or triple therapy)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Continuing treatment of combination therapy (dual or triple therapy, excluding selexipag)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Triple therapy - Initial treatment or continuing treatment of triple combination therapy
(including dual therapy in lieu of triple therapy) that includes selexipag
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 90 | # of repeats: 5 | DPMQ: $95.81 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction
Indication: Erectile dysfunction
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 4 | # of repeats: 5 | DPMQ: - | Max safety net: - | General Patient Charge: - |
| Available brands | |||||
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DPMQ: $57.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $57.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
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DPMQ: $57.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
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DPMQ: $57.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
Body System:
Manner of administration:Oral
Restriction
Indication: Erectile dysfunction
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 4 | # of repeats: 5 | DPMQ: - | Max safety net: - | General Patient Charge: - |
| Available brands | |||||
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DPMQ: $69.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
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DPMQ: $69.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
|
DPMQ: $69.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
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DPMQ: $69.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
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DPMQ: $30.43 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
|
DPMQ: $69.74 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
Body System:
Manner of administration:Oral
Restriction
Indication: Erectile dysfunction
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 4 | # of repeats: 5 | DPMQ: - | Max safety net: - | General Patient Charge: - |
| Available brands | |||||
|
|
DPMQ: $74.31 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
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DPMQ: $74.31 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
|
DPMQ: $74.31 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
|
DPMQ: $74.31 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
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DPMQ: $33.79 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
|
|
DPMQ: $74.31 | Max safety net: $7.70 | General Patient Charge: $7.70 | ||
Body System:
Manner of administration:Oral
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 1 (new patients)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 2 (change)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
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: 90 | # of repeats: 5 | DPMQ: $95.81 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
|
|
|||||
|
|
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|
|
|||||
|
|
|||||
Body System:
Manner of administration:Oral
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 1 (new patients)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
Treatment phase: Initial 2 (change)
Restriction
Indication: Pulmonary arterial hypertension (PAH)
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: 90 | # of repeats: 5 | DPMQ: $108.69 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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