RIVAROXABAN

RIVAROXABAN (12192Q)

rivaroxaban 2.5 mg tablet, 60
12192Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10992)

Indication: Chronic stable atherosclerotic disease
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: 60 # of repeats: 5 DPMQ: $35.41 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Rivaroxaban
RIVOXA
Rivaroxaban Lupin
Rivaroxaban-Teva
Xarelto

RIVAROXABAN (12197Y)

rivaroxaban 2.5 mg tablet, 60
12197Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 11013)

Indication: Chronic stable atherosclerotic disease
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: 60 # of repeats: 5 DPMQ: $35.41 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Rivaroxaban
RIVOXA
Rivaroxaban Lupin
Rivaroxaban-Teva
Xarelto

RIVAROXABAN (13366L)

rivaroxaban 2.5 mg tablet, 60
13366L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14298)

Indication: Chronic stable atherosclerotic disease
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: 120 # of repeats: 5 DPMQ: $57.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Rivaroxaban
RIVOXA
Rivaroxaban Lupin
Rivaroxaban-Teva
Xarelto