DICLOFENAC

DICLOFENAC (1299J)

diclofenac sodium 25 mg enteric tablet, 50
1299J
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: 2 Max qty units: 100 # of repeats: 3 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Clonac 25
DICLOFENAC-WGR
Diclofenac Sandoz
Fenac EC
Voltaren 25
*Additional charge for this brand is $9.96
 DPMQ: $29.18 Max safety net: $20.70 General Patient Charge: $33.45

DICLOFENAC (1300K)

diclofenac sodium 50 mg enteric tablet, 50
1300K
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: 50 # of repeats: 3 DPMQ: $16.70 Max safety net: $18.18 General Patient Charge: $20.97
Available brands
Clonac 50
DICLOFENAC-WGR
Diclofenac Sandoz
Fenac EC
Voltaren 50
*Additional charge for this brand is $9.95
 DPMQ: $26.65 Max safety net: $18.18 General Patient Charge: $30.92

DICLOFENAC (4046Y)

diclofenac sodium 3% gel, 25 g
4046Y
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Solar (actinic) keratosis
Treatment phase: Management
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 3 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Solaraze 3% Gel DPMQ: $63.35 Max safety net: $7.70 General Patient Charge: $7.70

DICLOFENAC (5076E)

diclofenac sodium 25 mg enteric tablet, 50
5076E
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: 2 Max qty units: 100 # of repeats: 0 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
Clonac 25
DICLOFENAC-WGR
Diclofenac Sandoz
Fenac EC
Voltaren 25
*Additional charge for this brand is $9.96
 DPMQ: $29.18 Max safety net: $20.70 General Patient Charge: $33.45

DICLOFENAC (5077F)

diclofenac sodium 50 mg enteric tablet, 50
5077F
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: 50 # of repeats: 0 DPMQ: $16.70 Max safety net: $18.18 General Patient Charge: $20.97
Available brands
Clonac 50
DICLOFENAC-WGR
Diclofenac Sandoz
Fenac EC
Voltaren 50
*Additional charge for this brand is $9.95
 DPMQ: $26.65 Max safety net: $18.18 General Patient Charge: $30.92