MESALAZINE

MESALAZINE (12203G)

mesalazine 1 g modified release granules, 100 sachets
12203G
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ulcerative colitis

Restriction

Indication: Crohn disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $105.07 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pentasa

MESALAZINE (13355X)

mesalazine 1 g modified release granules, 100 sachets
13355X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ulcerative colitis

Restriction

Indication: Crohn disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $199.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pentasa

MESALAZINE (13398E)

mesalazine 1 g modified release granules, 100 sachets
13398E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ulcerative colitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $217.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Salofalk

MESALAZINE (8599N)

mesalazine 1 g modified release granules, 100 sachets
8599N
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Ulcerative colitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $113.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Salofalk