PANTOPRAZOLE

PANTOPRAZOLE (11681T)

pantoprazole 40 mg enteric tablet, 30
11681T
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

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
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $16.88 Max safety net: $18.36 General Patient Charge: $21.15
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $4.95
 DPMQ: $21.83 Max safety net: $18.36 General Patient Charge: $26.10

PANTOPRAZOLE (12277E)

pantoprazole 40 mg enteric tablet, 30
12277E
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: 2 Max qty units: 60 # of repeats: 5 DPMQ: $19.98 Max safety net: $21.46 General Patient Charge: $24.25
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $9.90
 DPMQ: $29.88 Max safety net: $21.46 General Patient Charge: $34.15

PANTOPRAZOLE (14330F)

pantoprazole 40 mg enteric tablet, 30
14330F
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

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
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $19.98 Max safety net: $21.46 General Patient Charge: $24.25
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $9.90
 DPMQ: $29.88 Max safety net: $21.46 General Patient Charge: $34.15

PANTOPRAZOLE (14362X)

pantoprazole 40 mg enteric tablet, 30
14362X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

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: $19.98 Max safety net: $21.46 General Patient Charge: $24.25
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $9.90
 DPMQ: $29.88 Max safety net: $21.46 General Patient Charge: $34.15

PANTOPRAZOLE (14394N)

pantoprazole 40 mg enteric tablet, 30
14394N
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: $26.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $19.80
 DPMQ: $45.96 Max safety net: $25.00 General Patient Charge: $44.80

PANTOPRAZOLE (8007K)

pantoprazole 40 mg enteric tablet, 30
8007K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

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
Max qty packs: 1 Max qty units: 30 # of repeats: 1 DPMQ: $16.88 Max safety net: $18.36 General Patient Charge: $21.15
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $4.95
 DPMQ: $21.83 Max safety net: $18.36 General Patient Charge: $26.10

PANTOPRAZOLE (8008L)

pantoprazole 40 mg enteric tablet, 30
8008L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

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: $16.88 Max safety net: $18.36 General Patient Charge: $21.15
Available brands
APO-Pantoprazole
APX-PANTOPRAZOLE
BTC Pantoprazole
I-Pantoprazole
Ozpan
PANTOPRAZOLE-WGR
Panthron
Pantoprazole Sandoz
Pantoprazole generichealth
Salpraz
Sozol
Somac
*Additional charge for this brand is $4.95
 DPMQ: $21.83 Max safety net: $18.36 General Patient Charge: $26.10