MIRTAZAPINE

MIRTAZAPINE (14475W)

mirtazapine 45 mg orally disintegrating tablet, 30
14475W
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: 60 # of repeats: 2 DPMQ: $27.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
MIRTANZA ODT

MIRTAZAPINE (8857E)

mirtazapine 45 mg orally disintegrating tablet, 30
8857E
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: 30 # of repeats: 5 DPMQ: $20.86 Max safety net: $22.34 General Patient Charge: $25.00
Available brands
MIRTANZA ODT