CITALOPRAM

CITALOPRAM (14313H)

citalopram 10 mg tablet, 28
14313H
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: 56 # of repeats: 2 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
CITALOPRAM-WGR
Celapram
Talam

CITALOPRAM (14490P)

citalopram 20 mg tablet, 28
14490P
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: 56 # of repeats: 2 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
APO-Citalopram
APX-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam
Cipramil
*Additional charge for this brand is $26.30
 DPMQ: $45.52 Max safety net: $20.70 General Patient Charge: $49.79

CITALOPRAM (14518D)

citalopram 40 mg tablet, 28
14518D
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: 56 # of repeats: 2 DPMQ: $19.30 Max safety net: $20.78 General Patient Charge: $23.57
Available brands
APO-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam

CITALOPRAM (8220P)

citalopram 20 mg tablet, 28
8220P
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: 28 # of repeats: 5 DPMQ: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
APO-Citalopram
APX-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam
Cipramil
*Additional charge for this brand is $13.15
 DPMQ: $29.65 Max safety net: $17.98 General Patient Charge: $33.92

CITALOPRAM (8702B)

citalopram 10 mg tablet, 28
8702B
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: 28 # of repeats: 5 DPMQ: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
CITALOPRAM-WGR
Celapram
Talam

CITALOPRAM (8703C)

citalopram 40 mg tablet, 28
8703C
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: 28 # of repeats: 5 DPMQ: $16.54 Max safety net: $18.02 General Patient Charge: $20.81
Available brands
APO-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam