MIRTAZAPINE

MIRTAZAPINE (14473R)

mirtazapine 30 mg tablet, 30
14473R
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
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: $21.84 Max safety net: $23.38 General Patient Charge: $25.00
Available brands
APX-Mirtazapine
Axit 30
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz
Avanza
*Additional charge for this brand is $11.48
 DPMQ: $33.32 Max safety net: $23.38 General Patient Charge: $36.48

MIRTAZAPINE (8513C)

mirtazapine 30 mg tablet, 30
8513C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Major depressive disorders
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: $18.10 Max safety net: $19.64 General Patient Charge: $22.43
Available brands
APX-Mirtazapine
Axit 30
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz
Avanza
*Additional charge for this brand is $5.74
 DPMQ: $23.84 Max safety net: $19.64 General Patient Charge: $28.17