MOCLOBEMIDE

MOCLOBEMIDE (14442D)

moclobemide 300 mg tablet, 60
14442D
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: $32.50 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amira 300
Clobemix
MOCLOBEMIDE-WGR
Moclobemide Sandoz
Aurorix 300 mg
*Additional charge for this brand is $8.00
 DPMQ: $40.50 Max safety net: $25.00 General Patient Charge: $33.00

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: $25.00 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 $8.00
 DPMQ: $33.00 Max safety net: $25.00 General Patient Charge: $33.00

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: $19.39 Max safety net: $20.87 General Patient Charge: $23.66
Available brands
Amira 150
Clobemix
MOCLOBEMIDE-WGR
Moclobemide Sandoz
Aurorix
*Additional charge for this brand is $4.00
 DPMQ: $23.39 Max safety net: $20.87 General Patient Charge: $27.66

MOCLOBEMIDE (8003F)

moclobemide 300 mg tablet, 60
8003F
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: $23.14 Max safety net: $24.62 General Patient Charge: $25.00
Available brands
Amira 300
Clobemix
MOCLOBEMIDE-WGR
Moclobemide Sandoz
Aurorix 300 mg
*Additional charge for this brand is $4.00
 DPMQ: $27.14 Max safety net: $24.62 General Patient Charge: $29.00