DOXYCYCLINE

DOXYCYCLINE (10176N)

doxycycline 100 mg tablet, 21
10176N
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Urethritis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 21 # of repeats: 0 DPMQ: $22.18 Max safety net: $23.72 General Patient Charge: $25.00
Available brands
APX-Doxycycline
Doxsig
Doxylin 100

DOXYCYCLINE (10777F)

doxycycline 100 mg modified release capsule, 7
10777F
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $11.00
 DPMQ: $36.32 Max safety net: $25.00 General Patient Charge: $36.00
Mayne Pharma Doxycycline
*Additional charge for this brand is $5.72
 DPMQ: $31.04 Max safety net: $25.00 General Patient Charge: $30.72

DOXYCYCLINE (10779H)

doxycycline 100 mg tablet, 7
10779H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: $25.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Doxycycline
DOXYCYCLINE-WGR
Doxsig
Doxylin 100

DOXYCYCLINE (10781K)

doxycycline 100 mg tablet, 7
10781K
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: $25.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (14307B)

doxycycline 50 mg tablet, 25
14307B
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: $20.18 Max safety net: $21.72 General Patient Charge: $24.51
Available brands
APX-Doxycycline
DOXYCYCLINE-WGR
Doxsig
Doxylin 50

DOXYCYCLINE (14443E)

doxycycline 100 mg modified release capsule, 7
14443E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 2 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $22.00
 DPMQ: $58.28 Max safety net: $25.00 General Patient Charge: $47.00
Mayne Pharma Doxycycline
*Additional charge for this brand is $11.44
 DPMQ: $47.72 Max safety net: $25.00 General Patient Charge: $36.44

DOXYCYCLINE (14480D)

doxycycline 100 mg tablet, 7
14480D
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 2 DPMQ: $36.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Doxycycline
DOXYCYCLINE-WGR
Doxsig
Doxylin 100

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 $9.48
 DPMQ: $29.66 Max safety net: $21.72 General Patient Charge: $33.99
Mayne Pharma Doxycycline
*Additional charge for this brand is $4.82
 DPMQ: $25.00 Max safety net: $21.72 General Patient Charge: $29.33

DOXYCYCLINE (14511R)

doxycycline 100 mg tablet, 7
14511R
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 2 DPMQ: $36.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (14513W)

doxycycline 50 mg tablet, 25
14513W
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: $20.18 Max safety net: $21.72 General Patient Charge: $24.51
Available brands
Doxycycline Sandoz