AZITHROMYCIN

AZITHROMYCIN (4115N)

azithromycin 500 mg tablet, 3
4115N
Body System:
Manner of administration:Oral
Repatriation Pharmaceutical Benefits
Restricted Benefit

Restriction

Indication: Upper and lower respiratory tract infections
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 3 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Zithromax DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
APO-Azithromycin DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
Azithromycin Mylan DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
Azithromycin Sandoz DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
Azithromycin Viatris DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
Azithromycin-WGR DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
Zedd 500 DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70
ZITHRO DPMQ: $35.61 Max safety net: $7.70 General Patient Charge: $7.70

AZITHROMYCIN (5616N)

azithromycin 600 mg tablet, 8
5616N
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6356)

Indication: Mycobacterium avium complex infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 16 # of repeats: 5 DPMQ: $110.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zithromax

AZITHROMYCIN (6221K)

azithromycin 600 mg tablet, 8
6221K
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9604)

Indication: Mycobacterium avium complex infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 16 # of repeats: 5 DPMQ: $124.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zithromax

AZITHROMYCIN (8200N)

azithromycin 500 mg tablet, 2
8200N
Body System:
Manner of administration:Oral
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

AZITHROMYCIN (8201P)

azithromycin 200 mg/5 mL powder for oral liquid, 15 mL
8201P
Body System:
Manner of administration:Oral
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: 1 # of repeats: 0 DPMQ: $29.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zithromax

AZITHROMYCIN (8336R)

azithromycin 500 mg tablet, 2
8336R
Body System:
Manner of administration:Oral
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