FLUVOXAMINE

FLUVOXAMINE (14314J)

fluvoxamine maleate 100 mg tablet, 30
14314J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders

Restriction

Indication: Obsessive-compulsive disorder
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: 2 DPMQ: $30.98 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Fluvoxamine
FLUVOXAMINE-WGR
Faverin 100
Movox 100
Luvox
*Additional charge for this brand is $6.80
 DPMQ: $37.78 Max safety net: $25.00 General Patient Charge: $31.80

FLUVOXAMINE (8174F)

fluvoxamine maleate 100 mg tablet, 30
8174F
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders

Restriction

Indication: Obsessive-compulsive disorder
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: $22.67 Max safety net: $24.21 General Patient Charge: $25.00
Available brands
APO-Fluvoxamine
FLUVOXAMINE-WGR
Faverin 100
Movox 100
Luvox
*Additional charge for this brand is $3.40
 DPMQ: $26.07 Max safety net: $24.21 General Patient Charge: $28.40