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: $22.84 Max safety net: $24.38 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 $8.16
 DPMQ: $31.00 Max safety net: $24.38 General Patient Charge: $33.16

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: $41.86 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 $6.92
 DPMQ: $48.78 Max safety net: $25.00 General Patient Charge: $31.92

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: $24.26 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 $6.88
 DPMQ: $31.14 Max safety net: $25.00 General Patient Charge: $31.88

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: $30.72 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 $6.90
 DPMQ: $37.62 Max safety net: $25.00 General Patient Charge: $31.90

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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 25
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $4.08
 DPMQ: $22.68 Max safety net: $20.14 General Patient Charge: $27.01

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: $19.31 Max safety net: $20.85 General Patient Charge: $23.64
Available brands
APX-Lamotrigine
LAMITAN
LAMOTRIGINE-WGR
Lamotrigine GH
Logem
Reedos 50
Sandoz Lamotrigine
Lamictal
*Additional charge for this brand is $3.44
 DPMQ: $22.75 Max safety net: $20.85 General Patient Charge: $27.08

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: $22.54 Max safety net: $24.08 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 $3.45
 DPMQ: $25.99 Max safety net: $24.08 General Patient Charge: $28.45

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: $28.11 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 $3.46
 DPMQ: $31.57 Max safety net: $25.00 General Patient Charge: $28.46