FLUCONAZOLE

FLUCONAZOLE (1471K)

fluconazole 50 mg capsule, 28
1471K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15984)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 15975)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 6023)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 6030)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 5989)

Indication: Oesophageal candidiasis

Restriction (Streamlined authority code: 16034)

Indication: Fungal infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $19.51 Max safety net: $21.05 General Patient Charge: $23.84
Available brands
Dizole 50
Fluconazole Sandoz
Ozole
Diflucan
*Additional charge for this brand is $7.41
 DPMQ: $26.92 Max safety net: $21.05 General Patient Charge: $31.25

FLUCONAZOLE (1472L)

fluconazole 100 mg capsule, 28
1472L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15984)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 15975)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 6023)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 6030)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 5989)

Indication: Oesophageal candidiasis

Restriction (Streamlined authority code: 16034)

Indication: Fungal infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $24.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dizole 100
Fluconazole Sandoz
Ozole
Diflucan
*Additional charge for this brand is $10.44
 DPMQ: $34.76 Max safety net: $25.00 General Patient Charge: $35.44

FLUCONAZOLE (1475P)

fluconazole 200 mg capsule, 28
1475P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15984)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 15975)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 6023)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 6030)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 5989)

Indication: Oesophageal candidiasis

Restriction (Streamlined authority code: 16034)

Indication: Fungal infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $33.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Fluconazole
Dizole 200
FLUCONAZOLE-WGR
Fluconazole Sandoz
Fluzole 200
Ozole
Diflucan
*Additional charge for this brand is $15.68
 DPMQ: $49.46 Max safety net: $25.00 General Patient Charge: $40.68

FLUCONAZOLE (5446P)

fluconazole 50 mg/5 mL powder for oral liquid, 35 mL
5446P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16141)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 16148)

Indication: Cryptococcal meningitis

Restriction (Streamlined authority code: 6031)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 6032)

Indication: Oropharyngeal candidiasis

Restriction (Streamlined authority code: 6046)

Indication: Oesophageal candidiasis

Restriction (Streamlined authority code: 16114)

Indication: Fungal infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $69.55 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diflucan