ARIPIPRAZOLE

ARIPIPRAZOLE (10219W)

aripiprazole 400 mg modified release injection [1 vial] (&) inert substance diluent [2 mL vial], 1 pack
10219W
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
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: 5 DPMQ: $364.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARIPENA
Abilify Maintena

ARIPIPRAZOLE (10224D)

aripiprazole 300 mg modified release injection [1 vial] (&) inert substance diluent [2 mL vial], 1 pack
10224D
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
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: 5 DPMQ: $293.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Abilify Maintena

ARIPIPRAZOLE (14790K)

Aripiprazole 720 mg/2.4 mL modified release injection, 2.4 mL syringe
14790K
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16456)

Indication: Schizophrenia
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: 2 DPMQ: $578.59 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Abilify Asimtufii

ARIPIPRAZOLE (14824F)

Aripiprazole 960 mg/3.2 mL modified release injection, 3.2 mL syringe
14824F
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16456)

Indication: Schizophrenia
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: 2 DPMQ: $721.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Abilify Asimtufii

ARIPIPRAZOLE (15122X)

aripiprazole 400 mg modified release injection [1 chamber] (&) inert substance diluent [1.6 mL chamber], 1 dual chamber syringe
15122X
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
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: 5 DPMQ: $364.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Abilify Maintena

ARIPIPRAZOLE (15128F)

aripiprazole 300 mg modified release injection [1 chamber] (&) inert substance diluent [1.2 mL chamber], 1 dual chamber syringe
15128F
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
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: 5 DPMQ: $293.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Abilify Maintena

ARIPIPRAZOLE (8717T)

aripiprazole 10 mg tablet, 30
8717T
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $39.11 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Aripiprazole
ARIPIPRAZOLE-WGR
ARIZOLE
Abilify
Abyraz
Aripiprazole GH
Aripiprazole Sandoz

ARIPIPRAZOLE (8718W)

aripiprazole 15 mg tablet, 30
8718W
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $49.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Aripiprazole
ARIPIPRAZOLE-WGR
ARIZOLE
Abilify
Abyraz
Aripiprazole GH
Aripiprazole Sandoz

ARIPIPRAZOLE (8719X)

aripiprazole 20 mg tablet, 30
8719X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $57.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Aripiprazole
ARIPIPRAZOLE-WGR
ARIZOLE
Abilify
Abyraz
Aripiprazole GH
Aripiprazole Sandoz

ARIPIPRAZOLE (8720Y)

aripiprazole 30 mg tablet, 30
8720Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $67.09 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Aripiprazole
ARIPIPRAZOLE-WGR
ARIZOLE
Abilify
Abyraz
Aripiprazole GH
Aripiprazole Sandoz