CLONAZEPAM

CLONAZEPAM (11520H)

clonazepam 500 microgram tablet, 50
11520H
Body System:
Manner of administration:Oral
Palliative Care
Restricted Benefit

Restriction

Indication: For use in patients receiving palliative care
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 3 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Rivotril
*Additional charge for this brand is $1.84
 DPMQ: $22.42 Max safety net: $22.06 General Patient Charge: $26.69

CLONAZEPAM (11559J)

clonazepam 500 microgram tablet, 50
11559J
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Epilepsy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 200 # of repeats: 2 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Rivotril
*Additional charge for this brand is $3.68
 DPMQ: $31.04 Max safety net: $25.00 General Patient Charge: $28.68

CLONAZEPAM (12534Q)

clonazepam 1 mg/mL injection [5 x 1 mL ampoules] (&) inert substance diluent [5 x 1 mL ampoules], 1 pack
12534Q
Body System:
Manner of administration:Injection
Palliative Care
Restricted Benefit

Restriction

Indication: For use in patients receiving palliative care
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 5 # of repeats: 1 DPMQ: $24.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Rivotril

CLONAZEPAM (1805B)

clonazepam 500 microgram tablet, 100
1805B
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Epilepsy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 2 DPMQ: $27.34 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Paxam 0.5

CLONAZEPAM (1806C)

clonazepam 2 mg tablet, 100
1806C
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Epilepsy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 2 DPMQ: $32.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Paxam 2

CLONAZEPAM (1807D)

clonazepam 1 mg/mL injection [5 x 1 mL ampoules] (&) inert substance diluent [5 x 1 mL ampoules], 1 pack
1807D
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Epilepsy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 5 # of repeats: 0 DPMQ: $24.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Rivotril

CLONAZEPAM (1808E)

clonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL
1808E
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Epilepsy
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 0 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
Rivotril

CLONAZEPAM (3478C)

clonazepam 2.5 mg/mL (0.1 mg/drop) oral liquid, 10 mL
3478C
Body System:
Manner of administration:Oral
Prescriber Bag
No restrictions
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: 0 DPMQ: $17.55 Max safety net: $0.00 General Patient Charge: Nil
Available brands
Rivotril

CLONAZEPAM (5337X)

clonazepam 500 microgram tablet, 100
5337X
Body System:
Manner of administration:Oral
Palliative Care
Restricted Benefit

Restriction

Indication: For use in patients receiving palliative care
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 3 DPMQ: $20.56 Max safety net: $22.04 General Patient Charge: $24.83
Available brands
Paxam 0.5

CLONAZEPAM (5338Y)

clonazepam 2 mg tablet, 100
5338Y
Body System:
Manner of administration:Oral
Palliative Care
Restricted Benefit

Restriction

Indication: For use in patients receiving palliative care
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 3 DPMQ: $23.28 Max safety net: $24.76 General Patient Charge: $25.00
Available brands
Paxam 2