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: $23.88 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 $10.82
 DPMQ: $34.70 Max safety net: $25.00 General Patient Charge: $35.82

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: $21.84 Max safety net: $23.38 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 $10.76
 DPMQ: $32.60 Max safety net: $23.38 General Patient Charge: $35.76

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: $19.12 Max safety net: $20.66 General Patient Charge: $23.45
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
Progout 100
Progout Viatris
Zyloprim
*Additional charge for this brand is $5.41
 DPMQ: $24.53 Max safety net: $20.66 General Patient Charge: $28.86

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: $18.10 Max safety net: $19.64 General Patient Charge: $22.43
Available brands
ALLOPURINOL-WGR
APO-ALLOPURINOL
Allopurinol Sandoz
Allosig
NOUMED ALLOPURINOL
Progout 300
Progout Viatris
Zyloprim
*Additional charge for this brand is $5.38
 DPMQ: $23.48 Max safety net: $19.64 General Patient Charge: $27.81