SULFASALAZINE

SULFASALAZINE (13433B)

sulfasalazine 500 mg enteric tablet, 100
13433B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 400 # of repeats: 5 DPMQ: $100.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pyralin EN
Salazopyrin-EN
*Additional charge for this brand is $8.00
 DPMQ: $108.48 Max safety net: $25.00 General Patient Charge: $33.00

SULFASALAZINE (2096H)

sulfasalazine 500 mg enteric tablet, 100
2096H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: For prescribing by certain health practitioners
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: 5 DPMQ: $57.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pyralin EN
Salazopyrin-EN
*Additional charge for this brand is $4.00
 DPMQ: $61.14 Max safety net: $25.00 General Patient Charge: $29.00