DOXYCYCLINE

DOXYCYCLINE (14484H)

doxycycline 50 mg modified release capsule, 25
14484H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Bronchiectasis

Restriction

Indication: Chronic bronchitis

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 50 # of repeats: 2 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $10.00
 DPMQ: $29.56 Max safety net: $21.04 General Patient Charge: $33.83
Mayne Pharma Doxycycline
*Additional charge for this brand is $5.16
 DPMQ: $24.72 Max safety net: $21.04 General Patient Charge: $28.99

DOXYCYCLINE (2707L)

doxycycline 50 mg modified release capsule, 25
2707L
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Bronchiectasis

Restriction

Indication: Chronic bronchitis

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 25 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $5.00
 DPMQ: $21.67 Max safety net: $18.15 General Patient Charge: $25.94
Mayne Pharma Doxycycline
*Additional charge for this brand is $2.58
 DPMQ: $19.25 Max safety net: $18.15 General Patient Charge: $23.52