MIRTAZAPINE

mirtazapine 15 mg orally disintegrating tablet, 30
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: 60 # of repeats: 2 DPMQ: $22.08 Max safety net: $23.56 General Patient Charge: $25.00
Available brands
MIRTANZA ODT
mirtazapine 15 mg orally disintegrating tablet, 30
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: 30 # of repeats: 5 DPMQ: $17.93 Max safety net: $19.41 General Patient Charge: $22.20
Available brands
MIRTANZA ODT