QUETIAPINE

QUETIAPINE (5458G)

quetiapine 150 mg modified release tablet, 60
5458G
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $24.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Quetiapine XR
Quetia XR
Quetiapine Sandoz XR
Tevatiapine XR
Seroquel XR
*Additional charge for this brand is $15.02
 DPMQ: $39.34 Max safety net: $25.00 General Patient Charge: $40.02

QUETIAPINE (8456C)

quetiapine 25 mg tablet, 60
8456C
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 7927)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 0 DPMQ: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
APX-QUETIAPINE
Blooms The Chemist Quetiapine
Kaptan
Pharmacor Quetiapine 25
QUETIAPINE-WGR
Quetia 25
Quetiapine RBX
Quetiapine Sandoz Pharma
Syquet
Seroquel
*Additional charge for this brand is $10.71
 DPMQ: $29.31 Max safety net: $20.14 General Patient Charge: $33.64

QUETIAPINE (8457D)

quetiapine 100 mg tablet, 90
8457D
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 90 # of repeats: 5 DPMQ: $24.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-QUETIAPINE
Blooms The Chemist Quetiapine
Kaptan
Pharmacor Quetiapine 100
QUETIAPINE-WGR
Quetia 100
Quetiapine RBX
Quetiapine Sandoz Pharma
Syquet
Seroquel
*Additional charge for this brand is $9.17
 DPMQ: $33.49 Max safety net: $25.00 General Patient Charge: $34.17

QUETIAPINE (8458E)

quetiapine 200 mg tablet, 60
8458E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $27.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-QUETIAPINE
Blooms The Chemist Quetiapine
Kaptan
Pharmacor Quetiapine 200
QUETIAPINE-WGR
Quetia 200
Quetiapine RBX
Quetiapine Sandoz Pharma
Syquet
Seroquel
*Additional charge for this brand is $9.17
 DPMQ: $37.10 Max safety net: $25.00 General Patient Charge: $34.17

QUETIAPINE (8580N)

quetiapine 300 mg tablet, 60
8580N
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $34.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-QUETIAPINE
Blooms The Chemist Quetiapine
Kaptan
Pharmacor Quetiapine 300
QUETIAPINE-WGR
Quetia 300
Quetiapine RBX
Quetiapine Sandoz Pharma
Syquet
Seroquel
*Additional charge for this brand is $9.17
 DPMQ: $43.45 Max safety net: $25.00 General Patient Charge: $34.17

QUETIAPINE (9202H)

quetiapine 50 mg modified release tablet, 60
9202H
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $21.40 Max safety net: $22.94 General Patient Charge: $25.00
Available brands
APX-Quetiapine XR
QUETIAPINE-AS XR
Quetia XR
Quetiapine Sandoz XR
Tevatiapine XR
Seroquel XR
*Additional charge for this brand is $9.17
 DPMQ: $30.57 Max safety net: $22.94 General Patient Charge: $34.17

QUETIAPINE (9203J)

quetiapine 200 mg modified release tablet, 60
9203J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $34.85 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Quetiapine XR
QUETIAPINE-AS XR
Quetia XR
Quetiapine Sandoz XR
Tevatiapine XR
Seroquel XR
*Additional charge for this brand is $9.17
 DPMQ: $44.02 Max safety net: $25.00 General Patient Charge: $34.17

QUETIAPINE (9204K)

quetiapine 300 mg modified release tablet, 60
9204K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $40.67 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Quetiapine XR
QUETIAPINE-AS XR
Quetia XR
Quetiapine Sandoz XR
Tevatiapine XR
Seroquel XR
*Additional charge for this brand is $9.17
 DPMQ: $49.84 Max safety net: $25.00 General Patient Charge: $34.17

QUETIAPINE (9205L)

quetiapine 400 mg modified release tablet, 60
9205L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4246)

Indication: Schizophrenia

Restriction (Streamlined authority code: 5611)

Indication: Acute mania

Restriction (Streamlined authority code: 5869)

Indication: Bipolar I 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: 60 # of repeats: 5 DPMQ: $50.24 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Quetiapine XR
QUETIAPINE-AS XR
Quetia XR
Quetiapine Sandoz XR
Tevatiapine XR
Seroquel XR
*Additional charge for this brand is $9.17
 DPMQ: $59.41 Max safety net: $25.00 General Patient Charge: $34.17