DESVENLAFAXINE

DESVENLAFAXINE (10234P)

desvenlafaxine 50 mg modified release tablet, 28
10234P
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: $20.73 Max safety net: $22.21 General Patient Charge: $25.00
Available brands
APO-Desvenlafaxine MR
Desvenlafaxine GH XR

DESVENLAFAXINE (10241B)

desvenlafaxine 50 mg modified release tablet, 28
10241B
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: $20.73 Max safety net: $22.21 General Patient Charge: $25.00
Available brands
BTC Desvenlafaxine
DESVEN
DESVENLAFAXINE-WGR XR
Desfax
Desvenlafaxine Sandoz
Desvenlafaxine Sandoz Pharma
Desvenlafaxine Viatris

DESVENLAFAXINE (14383B)

desvenlafaxine 50 mg modified release tablet, 28
14383B
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: $27.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
BTC Desvenlafaxine
DESVEN
DESVENLAFAXINE-WGR XR
Desfax
Desvenlafaxine Sandoz
Desvenlafaxine Sandoz Pharma
Desvenlafaxine Viatris

DESVENLAFAXINE (14418W)

desvenlafaxine 50 mg modified release tablet, 28
14418W
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: $27.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Desvenlafaxine MR
Desvenlafaxine GH XR

DESVENLAFAXINE (14451N)

desvenlafaxine 50 mg modified release tablet, 28
14451N
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: - Max safety net: - General Patient Charge: -
Available brands
Pristiq
*Additional charge for this brand is $9.00
 DPMQ: $36.68 Max safety net: $25.00 General Patient Charge: $34.00

DESVENLAFAXINE (9366Y)

desvenlafaxine 50 mg modified release tablet, 28
9366Y
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: - Max safety net: - General Patient Charge: -
Available brands
Pristiq
*Additional charge for this brand is $4.50
 DPMQ: $25.23 Max safety net: $22.21 General Patient Charge: $29.50