TIAGABINE

TIAGABINE (13892E)

tiagabine 5 mg tablet, 50
13892E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17444)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 200 # of repeats: 5 DPMQ: $109.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril

TIAGABINE (13893F)

tiagabine 15 mg tablet, 50
13893F
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17444)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 200 # of repeats: 5 DPMQ: $295.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril

TIAGABINE (13947C)

tiagabine 10 mg tablet, 50
13947C
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17444)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 200 # of repeats: 5 DPMQ: $208.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril

TIAGABINE (8221Q)

tiagabine 5 mg tablet, 50
8221Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17445)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 5 DPMQ: $61.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril

TIAGABINE (8222R)

tiagabine 10 mg tablet, 50
8222R
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17445)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 5 DPMQ: $109.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril

TIAGABINE (8223T)

tiagabine 15 mg tablet, 50
8223T
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17445)

Indication: Focal onset seizures
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 5 DPMQ: $152.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gabitril