METHADONE

METHADONE (12520Y)

methadone hydrochloride 10 mg tablet, 20
12520Y
Body System:
Manner of administration:Oral
Palliative Care
Authority Required

Restriction

Indication: Severe disabling pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 120 # of repeats: 0 DPMQ: $51.10 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
METHADONE-AFT
Physeptone

METHADONE (13333R)

methadone hydrochloride 5 mg/mL oral liquid, 1 L
13333R
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16083)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 0.84 Max qty units: 840 # of repeats: 5 DPMQ: $45.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Aspen Methadone Syrup
Biodone Forte

METHADONE (13334T)

methadone hydrochloride 5 mg/mL oral liquid, 200 mL
13334T
Body System:
Manner of administration:Oral
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16083)

Indication: Opioid dependence
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4.2 Max qty units: 840 # of repeats: 5 DPMQ: $50.92 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Aspen Methadone Syrup
Biodone Forte

METHADONE (14193B)

methadone hydrochloride 10 mg/mL injection, 5 x 1 mL vials
14193B
Body System:
Manner of administration:Injection
Palliative Care
Authority Required

Restriction

Indication: Severe disabling pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 24 Max qty units: 120 # of repeats: 0 DPMQ: $907.42 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Physeptone

METHADONE (14202L)

methadone hydrochloride 10 mg/mL injection, 5 x 1 mL vials
14202L
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15996)

Indication: Chronic severe disabling pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids for less than 12 months

Restriction (Streamlined authority code: 15994)

Indication: Chronic severe disabling pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids for more than 12 months

Restriction (Streamlined authority code: 16000)

Indication: Chronic severe disabling pain
Treatment phase: Continuing PBS treatment after 1 June 2020
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 5 # of repeats: 0 DPMQ: $54.73 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Physeptone

METHADONE (1609Q)

methadone hydrochloride 10 mg tablet, 20
1609Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15996)

Indication: Chronic severe disabling pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids for less than 12 months

Restriction (Streamlined authority code: 15994)

Indication: Chronic severe disabling pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids for more than 12 months

Restriction (Streamlined authority code: 16000)

Indication: Chronic severe disabling pain
Treatment phase: Continuing PBS treatment after 1 June 2020
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 20 # of repeats: 0 DPMQ: $24.59 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
METHADONE-AFT
Physeptone

METHADONE (5399E)

methadone hydrochloride 5 mg/mL oral liquid, 200 mL
5399E
Body System:
Manner of administration:Oral
Palliative Care
Authority Required

Restriction

Indication: Chronic severe disabling pain
Treatment phase: Initial treatment, for up to 3 months
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 200 # of repeats: 2 DPMQ: $27.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Aspen Methadone Syrup

METHADONE (5400F)

methadone hydrochloride 5 mg/mL oral liquid, 200 mL
5400F
Body System:
Manner of administration:Oral
Palliative Care
Authority Required

Restriction

Indication: Chronic severe disabling pain
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: 200 # of repeats: 0 DPMQ: $27.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Aspen Methadone Syrup