LAMOTRIGINE

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Indication: Epileptic seizures

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 112	# of repeats: 5	DPMQ: $22.84	Max safety net: $24.38	General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 25
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $8.16			DPMQ: $31.00	Max safety net: $24.38	General Patient Charge: $33.16

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Indication: Bipolar disorder

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 1	Max qty units: 56	# of repeats: 5	DPMQ: $18.60	Max safety net: $20.14	General Patient Charge: $22.93
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $4.08			DPMQ: $22.68	Max safety net: $20.14	General Patient Charge: $27.01

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Indication: Bipolar disorder

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 2	Max qty units: 112	# of repeats: 5	DPMQ: $22.84	Max safety net: $24.38	General Patient Charge: $25.00
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $8.16			DPMQ: $31.00	Max safety net: $24.38	General Patient Charge: $33.16

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

Indication: Epileptic seizures

Quantities & Cost

Max qty packs	Max qty units	# of repeats	DPMQ	Max safety net	General Patient Charge
Max qty packs: 1	Max qty units: 56	# of repeats: 5	DPMQ: $18.60	Max safety net: $20.14	General Patient Charge: $22.93
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 25
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $4.08			DPMQ: $22.68	Max safety net: $20.14	General Patient Charge: $27.01

LAMOTRIGINE (13842M)