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: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
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: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APO-Citalopram
APX-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam
Cipramil
*Additional charge for this brand is $25.28
 DPMQ: $45.12 Max safety net: $21.38 General Patient Charge: $49.45

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: $19.92 Max safety net: $21.46 General Patient Charge: $24.25
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Citalopram
APX-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam
Cipramil
*Additional charge for this brand is $12.64
 DPMQ: $29.74 Max safety net: $18.64 General Patient Charge: $34.07

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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
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: $17.14 Max safety net: $18.68 General Patient Charge: $21.47
Available brands
APO-Citalopram
CITALOPRAM-WGR
Celapram
Citalopram Sandoz
Talam