MOCLOBEMIDE

MOCLOBEMIDE (14560H)

moclobemide 150 mg tablet, 60
14560H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 2 DPMQ: $25.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amira 150
Clobemix
MOCLOBEMIDE-WGR
Moclobemide Sandoz
Aurorix
*Additional charge for this brand is $7.72
 DPMQ: $32.98 Max safety net: $25.00 General Patient Charge: $32.72

MOCLOBEMIDE (1900B)

moclobemide 150 mg tablet, 60
1900B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $19.81 Max safety net: $21.35 General Patient Charge: $24.14
Available brands
Amira 150
Clobemix
MOCLOBEMIDE-WGR
Moclobemide Sandoz
Aurorix
*Additional charge for this brand is $3.86
 DPMQ: $23.67 Max safety net: $21.35 General Patient Charge: $28.00