LAMOTRIGINE

LAMOTRIGINE (13843N)

lamotrigine 200 mg tablet, 56
13843N
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

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: $42.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 200
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $5.94
 DPMQ: $48.08 Max safety net: $25.00 General Patient Charge: $30.94

LAMOTRIGINE (15350X)

lamotrigine 200 mg tablet, 56
15350X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

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: $27.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $2.97
 DPMQ: $30.93 Max safety net: $25.00 General Patient Charge: $27.97

LAMOTRIGINE (15351Y)

lamotrigine 200 mg tablet, 56
15351Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

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: $42.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lamotrigine GH
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $5.94
 DPMQ: $48.08 Max safety net: $25.00 General Patient Charge: $30.94

LAMOTRIGINE (2851C)

lamotrigine 200 mg tablet, 56
2851C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

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: $27.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 200
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $2.97
 DPMQ: $30.93 Max safety net: $25.00 General Patient Charge: $27.97