OMEPRAZOLE

OMEPRAZOLE (11677N)

omeprazole 20 mg enteric tablet, 30
11677N
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8776)

Indication: Gastro-oesophageal reflux disease
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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $6.87
 DPMQ: $25.47 Max safety net: $20.14 General Patient Charge: $29.80

OMEPRAZOLE (12270T)

omeprazole 20 mg enteric tablet, 30
12270T
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Complex gastro-oesophageal reflux disease (GORD)
Treatment phase: One of: (1) establishment of symptom control, (2) maintenance treatment, (3) re-establishment of symptom control
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: 5 DPMQ: $22.84 Max safety net: $24.38 General Patient Charge: $25.00
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $13.74
 DPMQ: $36.58 Max safety net: $24.38 General Patient Charge: $38.74

OMEPRAZOLE (14363Y)

omeprazole 20 mg enteric tablet, 30
14363Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Complex gastro-oesophageal reflux disease (GORD)
Treatment phase: One of: (1) establishment of symptom control, (2) maintenance treatment, (3) re-establishment of symptom control
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 120 # of repeats: 5 DPMQ: $31.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $27.48
 DPMQ: $58.80 Max safety net: $25.00 General Patient Charge: $52.48

OMEPRAZOLE (14397R)

omeprazole 20 mg enteric tablet, 30
14397R
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15658)

Indication: Scleroderma oesophagus

Restriction (Streamlined authority code: 15678)

Indication: Zollinger-Ellison syndrome
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: 5 DPMQ: $22.84 Max safety net: $24.38 General Patient Charge: $25.00
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $13.74
 DPMQ: $36.58 Max safety net: $24.38 General Patient Charge: $38.74

OMEPRAZOLE (14557E)

omeprazole 20 mg enteric tablet, 30
14557E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15530)

Indication: Gastro-oesophageal reflux disease
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: 5 DPMQ: $22.84 Max safety net: $24.38 General Patient Charge: $25.00
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $13.74
 DPMQ: $36.58 Max safety net: $24.38 General Patient Charge: $38.74

OMEPRAZOLE (14707C)

omeprazole 20 mg enteric tablet, 30
14707C
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8774)

Indication: Gastro-oesophageal reflux disease
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: 1 DPMQ: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $6.87
 DPMQ: $25.47 Max safety net: $20.14 General Patient Charge: $29.80

OMEPRAZOLE (9109K)

omeprazole 20 mg enteric tablet, 30
9109K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8775)

Indication: Peptic ulcer
Treatment phase: Initial treatment
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: 1 DPMQ: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $6.87
 DPMQ: $25.47 Max safety net: $20.14 General Patient Charge: $29.80

OMEPRAZOLE (9110L)

omeprazole 20 mg enteric tablet, 30
9110L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8780)

Indication: Scleroderma oesophagus

Restriction (Streamlined authority code: 8866)

Indication: Zollinger-Ellison syndrome
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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
Acimax Tablets
Omepral
Omeprazole Sandoz
Losec Tablets
*Additional charge for this brand is $6.87
 DPMQ: $25.47 Max safety net: $20.14 General Patient Charge: $29.80