ESOMEPRAZOLE

ESOMEPRAZOLE (12283L)

esomeprazole 40 mg enteric tablet, 30
12283L
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: 2 Max qty units: 60 # of repeats: 5 DPMQ: $28.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Esomeprazole
ESOMEPRAZOLE-WGR
Esomeprazole GH
Esomeprazole GxP
Esomeprazole RBX
Esomeprazole Viatris
Esopreze
Nexazole
Nexole
Nexium
*Additional charge for this brand is $13.58
 DPMQ: $42.10 Max safety net: $25.00 General Patient Charge: $38.58

ESOMEPRAZOLE (14373L)

esomeprazole 40 mg enteric tablet, 30
14373L
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: $28.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Esomeprazole
ESOMEPRAZOLE-WGR
Esomeprazole GH
Esomeprazole GxP
Esomeprazole RBX
Esomeprazole Viatris
Esopreze
Nexazole
Nexole
Nexium
*Additional charge for this brand is $13.58
 DPMQ: $42.10 Max safety net: $25.00 General Patient Charge: $38.58

ESOMEPRAZOLE (14512T)

esomeprazole 40 mg enteric tablet, 30
14512T
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: $42.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Esomeprazole
ESOMEPRAZOLE-WGR
Esomeprazole GH
Esomeprazole GxP
Esomeprazole RBX
Esomeprazole Viatris
Esopreze
Nexazole
Nexole
Nexium
*Additional charge for this brand is $27.16
 DPMQ: $69.84 Max safety net: $25.00 General Patient Charge: $52.16

ESOMEPRAZOLE (3401B)

esomeprazole 40 mg enteric tablet, 30
3401B
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: $21.44 Max safety net: $22.98 General Patient Charge: $25.00
Available brands
APO-Esomeprazole
ESOMEPRAZOLE-WGR
Esomeprazole GH
Esomeprazole GxP
Esomeprazole RBX
Esomeprazole Viatris
Esopreze
Nexazole
Nexole
Nexium
*Additional charge for this brand is $6.79
 DPMQ: $28.23 Max safety net: $22.98 General Patient Charge: $31.79

ESOMEPRAZOLE (8601Q)

esomeprazole 40 mg enteric tablet, 30
8601Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required

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: $21.44 Max safety net: $22.98 General Patient Charge: $25.00
Available brands
APO-Esomeprazole
ESOMEPRAZOLE-WGR
Esomeprazole GH
Esomeprazole GxP
Esomeprazole RBX
Esomeprazole Viatris
Esopreze
Nexazole
Nexole
Nexium
*Additional charge for this brand is $6.79
 DPMQ: $28.23 Max safety net: $22.98 General Patient Charge: $31.79