Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13523RMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 60 (PI, CMI)	2	120	5	$93.33	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $20.00B	2	120	5	$113.33	$31.60	$51.60

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2753XMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 60 (PI, CMI)	1	60	5	$53.39	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $10.00B	1	60	5	$63.39	$31.60	$41.60

Source	General Schedule
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTITHROMBOTIC AGENTS > ANTITHROMBOTIC AGENTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
9321NMPNP	DABIGATRAN dabigatran etexilate 110 mg capsule, 60 (PI, CMI)	1	60	0	$53.39	$31.60	$31.60
	Available brands
	ARX-Dabigatrana
	Dabigatran Sandoza
	PHARMACOR DABIGATRANa
	Pradaxaa * Additional charge for this brand is $10.00B	1	60	0	$63.39	$31.60	$41.60