APIXABAN

APIXABAN (13464P)

apixaban 2.5 mg tablet, 60
13464P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14301)

Indication: Prevention of stroke or systemic embolism

Restriction (Streamlined authority code: 14300)

Indication: Prevention of recurrent venous thromboembolism
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $95.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APIXABAN-WGR
APO-Apixaban
Apexa
Apixaban Lupin
Apixaban Sandoz
Apixaban-APX
Cip Apixaban 2.5
Eliquis

APIXABAN (13525W)

apixaban 5 mg tablet, 60
13525W
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14301)

Indication: Prevention of stroke or systemic embolism

Restriction (Streamlined authority code: 18525)

Indication: Deep vein thrombosis

Restriction (Streamlined authority code: 18527)

Indication: Pulmonary embolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $93.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APIXABAN-WGR
APO-Apixaban
Apexa
Apixaban Lupin
Apixaban Sandoz
Apixaban-APX
Cip Apixaban 5
Eliquis

APIXABAN (2735Y)

apixaban 5 mg tablet, 60
2735Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4269)

Indication: Prevention of stroke or systemic embolism

Restriction (Streamlined authority code: 18513)

Indication: Deep vein thrombosis

Restriction (Streamlined authority code: 18522)

Indication: Pulmonary embolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $53.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APIXABAN-WGR
APO-Apixaban
Apexa
Apixaban Lupin
Apixaban Sandoz
Apixaban-APX
Cip Apixaban 5
Eliquis

APIXABAN (2744K)

apixaban 2.5 mg tablet, 60
2744K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4269)

Indication: Prevention of stroke or systemic embolism

Restriction (Streamlined authority code: 4132)

Indication: Prevention of recurrent venous thromboembolism
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $54.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APIXABAN-WGR
APO-Apixaban
Apexa
Apixaban Lupin
Apixaban Sandoz
Apixaban-APX
Cip Apixaban 2.5
Eliquis

APIXABAN (5054B)

apixaban 2.5 mg tablet, 30
5054B
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4382)

Indication: Prevention of venous thromboembolism

Restriction (Streamlined authority code: 4409)

Indication: Prevention of venous thromboembolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 0 DPMQ: $34.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Apexa
Cip Apixaban 2.5
Eliquis

APIXABAN (5061J)

apixaban 2.5 mg tablet, 60
5061J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4402)

Indication: Prevention of venous thromboembolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 0 DPMQ: $54.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APIXABAN-WGR
APO-Apixaban
Apexa
Apixaban Lupin
Apixaban Sandoz
Apixaban-APX
Cip Apixaban 2.5
Eliquis

APIXABAN (5500L)

apixaban 2.5 mg tablet, 20
5500L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4381)

Indication: Prevention of venous thromboembolism

Restriction (Streamlined authority code: 4359)

Indication: Prevention of venous thromboembolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 20 # of repeats: 0 DPMQ: $27.87 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Apexa
Apixaban-APX
Cip Apixaban 2.5
Eliquis