AZITHROMYCIN

General Schedule
Restricted Benefit

Restriction

Indication: Urethritis

Restriction

Indication: Cervicitis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 0 DPMQ: $18.18 Max safety net: $19.66 General Patient Charge: $22.45
Available brands
APO-Azithromycin
AZITHROMYCIN-WGR
Azithromycin Sandoz
Azithromycin Viatris
ZITHRO
Zithromax
General Schedule
Restricted Benefit

Restriction

Indication: Trachoma
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 2 DPMQ: $18.18 Max safety net: $19.66 General Patient Charge: $22.45
Available brands
APO-Azithromycin
AZITHROMYCIN-WGR
Azithromycin Sandoz
Azithromycin Viatris
ZITHRO
Zithromax