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: $21.84 Max safety net: $23.38 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 $11.48
 DPMQ: $33.32 Max safety net: $23.38 General Patient Charge: $36.48

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: $20.30 Max safety net: $21.84 General Patient Charge: $24.63
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: $24.34 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: $18.10 Max safety net: $19.64 General Patient Charge: $22.43
Available brands
APX-Mirtazapine
Axit 30
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz
Avanza
*Additional charge for this brand is $5.74
 DPMQ: $23.84 Max safety net: $19.64 General Patient Charge: $28.17

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: $19.35 Max safety net: $20.89 General Patient Charge: $23.68
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: $17.33 Max safety net: $18.87 General Patient Charge: $21.66
Available brands
APX-Mirtazapine
Axit 15
Blooms The Chemist Mirtazapine
MIRTANZA
MIRTAZAPINE-WGR
Mirtazapine Sandoz