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: $30.94 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 $7.00
 DPMQ: $37.94 Max safety net: $25.00 General Patient Charge: $32.00

FLUVOXAMINE (14488M)

fluvoxamine maleate 50 mg tablet, 30
14488M
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: $25.12 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Fluvoxamine
FLUVOXAMINE-WGR
Faverin 50
Movox 50
Luvox
*Additional charge for this brand is $7.00
 DPMQ: $32.12 Max safety net: $25.00 General Patient Charge: $32.00

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: $22.36 Max safety net: $23.84 General Patient Charge: $25.00
Available brands
APO-Fluvoxamine
FLUVOXAMINE-WGR
Faverin 100
Movox 100
Luvox
*Additional charge for this brand is $3.50
 DPMQ: $25.86 Max safety net: $23.84 General Patient Charge: $28.50

FLUVOXAMINE (8512B)

fluvoxamine maleate 50 mg tablet, 30
8512B
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: $19.45 Max safety net: $20.93 General Patient Charge: $23.72
Available brands
APO-Fluvoxamine
FLUVOXAMINE-WGR
Faverin 50
Movox 50
Luvox
*Additional charge for this brand is $3.50
 DPMQ: $22.95 Max safety net: $20.93 General Patient Charge: $27.22