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: $23.92	Max safety net: $25.00	General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 50
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $7.16			DPMQ: $31.08	Max safety net: $25.00	General Patient Charge: $32.16

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: 2	Max qty units: 112	# of repeats: 5	DPMQ: $23.92	Max safety net: $25.00	General Patient Charge: $25.00
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $7.16			DPMQ: $31.08	Max safety net: $25.00	General Patient Charge: $32.16

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: $18.85	Max safety net: $20.33	General Patient Charge: $23.12
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $3.58			DPMQ: $22.43	Max safety net: $20.33	General Patient Charge: $26.70

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: $18.85	Max safety net: $20.33	General Patient Charge: $23.12
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 50
Sandoz Lamotrigine
Lamictal *Additional charge for this brand is $3.58			DPMQ: $22.43	Max safety net: $20.33	General Patient Charge: $26.70

LAMOTRIGINE (13975M)