ESOMEPRAZOLE
Manner of administration:Oral
Restriction
Indication: Complex gastro-oesophageal reflux disease (GORD)
Treatment phase: One of: (1) establishment of symptom control, (2) maintenance treatment, (3) re-establishment
of symptom control
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $28.40 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $42.40 | Max safety net: $25.00 | General Patient Charge: $39.00 | ||
Manner of administration:Oral
Restriction
Indication: Pathological hypersecretory conditions including Zollinger-Ellison syndrome and idiopathic
hypersecretion
Restriction
Indication: Scleroderma oesophagus
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: 5 | DPMQ: $28.40 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $42.40 | Max safety net: $25.00 | General Patient Charge: $39.00 | ||
Manner of administration:Oral
Restriction
Indication: Complex gastro-oesophageal reflux disease (GORD)
Treatment phase: One of: (1) establishment of symptom control, (2) maintenance treatment, (3) re-establishment
of symptom control
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 120 | # of repeats: 5 | DPMQ: $43.00 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $71.00 | Max safety net: $25.00 | General Patient Charge: $53.00 | ||
Manner of administration:Oral
Restriction
Indication: Pathological hypersecretory conditions including Zollinger-Ellison syndrome and idiopathic
hypersecretion
Restriction
Indication: Scleroderma oesophagus
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: $21.09 | Max safety net: $22.57 | General Patient Charge: $25.00 |
| Available brands | |||||
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DPMQ: $28.09 | Max safety net: $22.57 | General Patient Charge: $32.00 | ||
Manner of administration:Oral
Restriction
Indication: Gastro-oesophageal reflux disease
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: 1 | DPMQ: $21.09 | Max safety net: $22.57 | General Patient Charge: $25.00 |
| Available brands | |||||
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DPMQ: $28.09 | Max safety net: $22.57 | General Patient Charge: $32.00 | ||