DESVENLAFAXINE

DESVENLAFAXINE (10231L)

desvenlafaxine 100 mg modified release tablet, 28
10231L
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: $22.31 Max safety net: $23.79 General Patient Charge: $25.00
Available brands
BTC Desvenlafaxine
DESVEN
DESVENLAFAXINE-WGR XR
Desfax
Desvenlafaxine Sandoz
Desvenlafaxine Sandoz Pharma
Desvenlafaxine Viatris

DESVENLAFAXINE (10245F)

desvenlafaxine 100 mg modified release tablet, 28
10245F
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: $22.31 Max safety net: $23.79 General Patient Charge: $25.00
Available brands
APO-Desvenlafaxine MR
Desvenlafaxine GH XR

DESVENLAFAXINE (14384C)

desvenlafaxine 100 mg modified release tablet, 28
14384C
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: $30.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Desvenlafaxine MR
Desvenlafaxine GH XR

DESVENLAFAXINE (14489N)

desvenlafaxine 100 mg modified release tablet, 28
14489N
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: $30.84 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 (14545M)

desvenlafaxine 100 mg modified release tablet, 28
14545M
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: $39.84 Max safety net: $25.00 General Patient Charge: $34.00

DESVENLAFAXINE (9367B)

desvenlafaxine 100 mg modified release tablet, 28
9367B
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: $26.81 Max safety net: $23.79 General Patient Charge: $29.50