DONEPEZIL

DONEPEZIL (2479L)

donepezil hydrochloride 10 mg tablet, 28
2479L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13938)

Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Continuing
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $18.30 Max safety net: $19.78 General Patient Charge: $22.57
Available brands
APO-Donepezil
Arazil
Aridon 10
Aridon APN 10
DONEPEZIL-WGR
Donepezil GH
Donepezil Sandoz
Aricept
*Additional charge for this brand is $4.47
 DPMQ: $22.77 Max safety net: $19.78 General Patient Charge: $27.04

DONEPEZIL (2532G)

donepezil hydrochloride 5 mg tablet, 28
2532G
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13938)

Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Continuing
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $18.30 Max safety net: $19.78 General Patient Charge: $22.57
Available brands
APO-Donepezil
Arazil
Aridon 5
Aridon APN 5
DONEPEZIL-WGR
Donepezil GH
Donepezil Sandoz
Aricept
*Additional charge for this brand is $4.50
 DPMQ: $22.80 Max safety net: $19.78 General Patient Charge: $27.07

DONEPEZIL (8495D)

donepezil hydrochloride 5 mg tablet, 28
8495D
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Initial

Restriction

Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Initial
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $18.30 Max safety net: $19.78 General Patient Charge: $22.57
Available brands
APO-Donepezil
Arazil
Aridon 5
Aridon APN 5
DONEPEZIL-WGR
Donepezil GH
Donepezil Sandoz
Aricept
*Additional charge for this brand is $4.50
 DPMQ: $22.80 Max safety net: $19.78 General Patient Charge: $27.07

DONEPEZIL (8496E)

donepezil hydrochloride 10 mg tablet, 28
8496E
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Initial

Restriction

Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Initial
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $18.30 Max safety net: $19.78 General Patient Charge: $22.57
Available brands
APO-Donepezil
Arazil
Aridon 10
Aridon APN 10
DONEPEZIL-WGR
Donepezil GH
Donepezil Sandoz
Aricept
*Additional charge for this brand is $4.47
 DPMQ: $22.77 Max safety net: $19.78 General Patient Charge: $27.04