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: $30.66	Max safety net: $25.00	General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 100
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $7.12			DPMQ: $37.78	Max safety net: $25.00	General Patient Charge: $32.12

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: $30.66	Max safety net: $25.00	General Patient Charge: $25.00
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $7.12			DPMQ: $37.78	Max safety net: $25.00	General Patient Charge: $32.12

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: $22.22	Max safety net: $23.70	General Patient Charge: $25.00
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $3.56			DPMQ: $25.78	Max safety net: $23.70	General Patient Charge: $28.56

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: $22.22	Max safety net: $23.70	General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 100
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $3.56			DPMQ: $25.78	Max safety net: $23.70	General Patient Charge: $28.56

LAMOTRIGINE (14052N)