GLICLAZIDE

GLICLAZIDE (13896J)

gliclazide 80 mg tablet, 100
13896J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $24.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Gliclazide
Nidem

GLICLAZIDE (13922R)

gliclazide 60 mg modified release tablet, 60
13922R
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $22.22 Max safety net: $23.70 General Patient Charge: $25.00
Available brands
ARDIX GLICLAZIDE 60mg MR
Gliclazide Lupin MR
Gliclazide Sandoz MR
Pharmacor Gliclazide MR
Diamicron 60mg MR
*Additional charge for this brand is $19.90
 DPMQ: $42.12 Max safety net: $23.70 General Patient Charge: $44.90

GLICLAZIDE (14740T)

gliclazide 30 mg modified release tablet, 100
14740T
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 200 # of repeats: 5 DPMQ: $24.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Gliclazide MR
Gliclazide MR Viatris
Gliclazide Sandoz MR
Pharmacor Gliclazide MR

GLICLAZIDE (2449X)

gliclazide 80 mg tablet, 100
2449X
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $18.92 Max safety net: $20.40 General Patient Charge: $23.19
Available brands
APX-Gliclazide
Nidem

GLICLAZIDE (8535F)

gliclazide 30 mg modified release tablet, 100
8535F
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 100 # of repeats: 5 DPMQ: $19.07 Max safety net: $20.55 General Patient Charge: $23.34
Available brands
APO-Gliclazide MR
Gliclazide MR Viatris
Gliclazide Sandoz MR
Pharmacor Gliclazide MR

GLICLAZIDE (9302N)

gliclazide 60 mg modified release tablet, 60
9302N
Body System:
Manner of administration:Oral
General Schedule
No restrictions
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: $18.00 Max safety net: $19.48 General Patient Charge: $22.27
Available brands
ARDIX GLICLAZIDE 60mg MR
Gliclazide Lupin MR
Gliclazide Sandoz MR
Pharmacor Gliclazide MR
Diamicron 60mg MR
*Additional charge for this brand is $9.95
 DPMQ: $27.95 Max safety net: $19.48 General Patient Charge: $32.22