OXYCODONE + NALOXONE
oxycodone hydrochloride 30 mg + naloxone hydrochloride 15 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 10755)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for less than 12 months
Restriction (Streamlined authority code: 10748)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for more than 12 months
Restriction (Streamlined authority code: 10752)
Indication: Chronic severe pain
Treatment phase: Continuing PBS treatment after 1 June 2020
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: 0 | DPMQ: $58.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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oxycodone hydrochloride 40 mg + naloxone hydrochloride 20 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction
Indication: Severe disabling pain
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: 0 | DPMQ: $93.17 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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oxycodone hydrochloride 20 mg + naloxone hydrochloride 10 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction
Indication: Severe disabling pain
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: 0 | DPMQ: $68.45 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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oxycodone hydrochloride 5 mg + naloxone hydrochloride 2.5 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction
Indication: Severe disabling pain
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: 0 | DPMQ: $45.71 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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oxycodone hydrochloride 10 mg + naloxone hydrochloride 5 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction
Indication: Severe disabling pain
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: 0 | DPMQ: $47.35 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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oxycodone hydrochloride 30 mg + naloxone hydrochloride 15 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction
Indication: Severe disabling pain
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: 0 | DPMQ: $96.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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oxycodone hydrochloride 5 mg + naloxone hydrochloride 2.5 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 10755)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for less than 12 months
Restriction (Streamlined authority code: 10748)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for more than 12 months
Restriction (Streamlined authority code: 10752)
Indication: Chronic severe pain
Treatment phase: Continuing PBS treatment after 1 June 2020
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: 0 | DPMQ: $32.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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oxycodone hydrochloride 10 mg + naloxone hydrochloride 5 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 10755)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for less than 12 months
Restriction (Streamlined authority code: 10748)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for more than 12 months
Restriction (Streamlined authority code: 10752)
Indication: Chronic severe pain
Treatment phase: Continuing PBS treatment after 1 June 2020
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: 0 | DPMQ: $33.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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oxycodone hydrochloride 20 mg + naloxone hydrochloride 10 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 10755)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for less than 12 months
Restriction (Streamlined authority code: 10748)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for more than 12 months
Restriction (Streamlined authority code: 10752)
Indication: Chronic severe pain
Treatment phase: Continuing PBS treatment after 1 June 2020
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: 0 | DPMQ: $44.27 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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oxycodone hydrochloride 40 mg + naloxone hydrochloride 20 mg modified release tablet,
28
Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 10755)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for less than 12 months
Restriction (Streamlined authority code: 10748)
Indication: Chronic severe pain
Treatment phase: Initial PBS treatment after 1 June 2020 where patient has been treated with opioids
for more than 12 months
Restriction (Streamlined authority code: 10752)
Indication: Chronic severe pain
Treatment phase: Continuing PBS treatment after 1 June 2020
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: 0 | DPMQ: $56.63 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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