LAMOTRIGINE

LAMOTRIGINE (13842M)

lamotrigine 25 mg tablet, 56
13842M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $22.40 Max safety net: $23.88 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 25
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $8.56
 DPMQ: $30.96 Max safety net: $23.88 General Patient Charge: $33.56

LAMOTRIGINE (13843N)

lamotrigine 200 mg tablet, 56
13843N
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $42.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 200
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $5.94
 DPMQ: $48.08 Max safety net: $25.00 General Patient Charge: $30.94

LAMOTRIGINE (13975M)

lamotrigine 50 mg tablet, 56
13975M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $23.92 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 50
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $7.16
 DPMQ: $31.08 Max safety net: $25.00 General Patient Charge: $32.16

LAMOTRIGINE (14052N)

lamotrigine 100 mg tablet, 56
14052N
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $30.66 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 100
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $7.12
 DPMQ: $37.78 Max safety net: $25.00 General Patient Charge: $32.12

LAMOTRIGINE (2848X)

lamotrigine 25 mg tablet, 56
2848X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $18.09 Max safety net: $19.57 General Patient Charge: $22.36
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 25
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $4.28
 DPMQ: $22.37 Max safety net: $19.57 General Patient Charge: $26.64

LAMOTRIGINE (2849Y)

lamotrigine 50 mg tablet, 56
2849Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $18.85 Max safety net: $20.33 General Patient Charge: $23.12
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 50
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $3.58
 DPMQ: $22.43 Max safety net: $20.33 General Patient Charge: $26.70

LAMOTRIGINE (2850B)

lamotrigine 100 mg tablet, 56
2850B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $22.22 Max safety net: $23.70 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 100
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $3.56
 DPMQ: $25.78 Max safety net: $23.70 General Patient Charge: $28.56

LAMOTRIGINE (2851C)

lamotrigine 200 mg tablet, 56
2851C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Epileptic seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $27.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 200
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $2.97
 DPMQ: $30.93 Max safety net: $25.00 General Patient Charge: $27.97