PANTOPRAZOLE
Manner of administration:Oral
Restriction (Streamlined authority code: 8776)
Indication: Gastro-oesophageal reflux disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 1 | Max qty units: 30 | # of repeats: 5 | DPMQ: $17.47 | Max safety net: $19.01 | General Patient Charge: $21.80 |
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DPMQ: $22.16 | Max safety net: $19.01 | General Patient Charge: $26.49 | ||
Manner of administration:Oral
Restriction
Indication: Complex gastro-oesophageal reflux disease (GORD)
Treatment phase: One of: (1) establishment of symptom control, (2) maintenance treatment, (3) re-establishment
of symptom control
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $20.58 | Max safety net: $22.12 | General Patient Charge: $24.91 |
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DPMQ: $29.96 | Max safety net: $22.12 | General Patient Charge: $34.29 | ||
Manner of administration:Oral
Restriction (Streamlined authority code: 15658)
Indication: Scleroderma oesophagus
Restriction (Streamlined authority code: 15678)
Indication: Zollinger-Ellison syndrome
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $20.58 | Max safety net: $22.12 | General Patient Charge: $24.91 |
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DPMQ: $29.96 | Max safety net: $22.12 | General Patient Charge: $34.29 | ||
Manner of administration:Oral
Restriction (Streamlined authority code: 15530)
Indication: Gastro-oesophageal reflux disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $20.58 | Max safety net: $22.12 | General Patient Charge: $24.91 |
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DPMQ: $29.96 | Max safety net: $22.12 | General Patient Charge: $34.29 | ||
Manner of administration:Oral
Restriction
Indication: Complex gastro-oesophageal reflux disease (GORD)
Treatment phase: One of: (1) establishment of symptom control, (2) maintenance treatment, (3) re-establishment
of symptom control
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 120 | # of repeats: 5 | DPMQ: $26.80 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $45.56 | Max safety net: $25.00 | General Patient Charge: $43.76 | ||
Manner of administration:Oral
Restriction (Streamlined authority code: 8775)
Indication: Peptic ulcer
Treatment phase: Initial treatment
Restriction (Streamlined authority code: 8774)
Indication: Gastro-oesophageal reflux disease
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 1 | Max qty units: 30 | # of repeats: 1 | DPMQ: $17.47 | Max safety net: $19.01 | General Patient Charge: $21.80 |
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DPMQ: $22.16 | Max safety net: $19.01 | General Patient Charge: $26.49 | ||
Manner of administration:Oral
Restriction (Streamlined authority code: 8780)
Indication: Scleroderma oesophagus
Restriction (Streamlined authority code: 8866)
Indication: Zollinger-Ellison syndrome
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: 5 | DPMQ: $17.47 | Max safety net: $19.01 | General Patient Charge: $21.80 |
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DPMQ: $22.16 | Max safety net: $19.01 | General Patient Charge: $26.49 | ||