ALLOPURINOL

ALLOPURINOL (13358C)

allopurinol 100 mg tablet, 200
13358C
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: 2 Max qty units: 400 # of repeats: 2 DPMQ: $23.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
Progout 100
Progout Viatris
Zyloprim
*Additional charge for this brand is $11.24
 DPMQ: $34.76 Max safety net: $25.00 General Patient Charge: $36.24

ALLOPURINOL (13575L)

allopurinol 300 mg tablet, 60
13575L
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: 2 Max qty units: 120 # of repeats: 2 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
NOUMED ALLOPURINOL
Progout 300
Progout Viatris
Zyloprim
*Additional charge for this brand is $11.28
 DPMQ: $32.60 Max safety net: $22.80 General Patient Charge: $36.28

ALLOPURINOL (2600W)

allopurinol 100 mg tablet, 200
2600W
Body System:
Manner of administration:Oral
General Schedule
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: 200 # of repeats: 2 DPMQ: $18.65 Max safety net: $20.13 General Patient Charge: $22.92
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
Progout 100
Progout Viatris
Zyloprim
*Additional charge for this brand is $5.62
 DPMQ: $24.27 Max safety net: $20.13 General Patient Charge: $28.54

ALLOPURINOL (2604C)

allopurinol 300 mg tablet, 60
2604C
Body System:
Manner of administration:Oral
General Schedule
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: 60 # of repeats: 2 DPMQ: $17.55 Max safety net: $19.03 General Patient Charge: $21.82
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
NOUMED ALLOPURINOL
Progout 300
Progout Viatris
Zyloprim
*Additional charge for this brand is $5.64
 DPMQ: $23.19 Max safety net: $19.03 General Patient Charge: $27.46