MIRTAZAPINE

MIRTAZAPINE (14473R)

mirtazapine 30 mg tablet, 30
14473R
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: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
APX-Mirtazapine
Axit 30
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz
Avanza
*Additional charge for this brand is $12.02
 DPMQ: $33.34 Max safety net: $22.80 General Patient Charge: $37.02

MIRTAZAPINE (14507M)

mirtazapine 15 mg tablet, 30
14507M
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: $19.68 Max safety net: $21.16 General Patient Charge: $23.95
Available brands
APX-Mirtazapine
Axit 15
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz

MIRTAZAPINE (14561J)

mirtazapine 45 mg tablet, 30
14561J
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: $24.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Mirtazapine
Axit 45
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz

MIRTAZAPINE (8513C)

mirtazapine 30 mg tablet, 30
8513C
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: $17.55 Max safety net: $19.03 General Patient Charge: $21.82
Available brands
APX-Mirtazapine
Axit 30
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz
Avanza
*Additional charge for this brand is $6.01
 DPMQ: $23.56 Max safety net: $19.03 General Patient Charge: $27.83

MIRTAZAPINE (8883M)

mirtazapine 45 mg tablet, 30
8883M
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: $18.90 Max safety net: $20.38 General Patient Charge: $23.17
Available brands
APX-Mirtazapine
Axit 45
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz

MIRTAZAPINE (9365X)

mirtazapine 15 mg tablet, 30
9365X
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: $16.73 Max safety net: $18.21 General Patient Charge: $21.00
Available brands
APX-Mirtazapine
Axit 15
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz