Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
1594XMPNP	ONDANSETRON ondansetron 4 mg tablet, 10 (PI, CMI)	1	10	1	$22.87	$24.32	$27.77
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 4a

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
1595YMPNP	ONDANSETRON ondansetron 8 mg tablet, 10 (PI, CMI)	1	10	1	$25.10	$26.55	$30.00
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 8a

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5470XMPNP	ONDANSETRON ondansetron 4 mg orally disintegrating tablet, 4 (PI, CMI)	1	4	0	$17.37	$18.82	$22.27
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5471YMPNP	ONDANSETRON ondansetron 8 mg orally disintegrating tablet, 4 (PI, CMI)	1	4	0	$18.20	$19.65	$23.10
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
5472BMPNP	ONDANSETRON ondansetron 4 mg orally disintegrating tablet, 10 (PI, CMI)	1	10	1	$22.87	$24.32	$27.77
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Lupina
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
5473CMPNP	ONDANSETRON ondansetron 8 mg orally disintegrating tablet, 10 (PI, CMI)	1	10	1	$25.10	$26.55	$30.00
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Lupina
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5848TMP	ONDANSETRON ondansetron 4 mg/5 mL oral liquid, 50 mL (PI, CMI)	1	1	0	$80.78	$31.60	$31.60
	Available brands
	Zofran syrup 50 mL

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5857GMP	ONDANSETRON ondansetron 4 mg orally disintegrating tablet, 4 (PI, CMI)	1	4	0	$3.50	$4.95	$4.95
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5858HMP	ONDANSETRON ondansetron 8 mg orally disintegrating tablet, 4 (PI, CMI)	1	4	0	$4.33	$5.78	$5.78
	Available brands
	APX-Ondansetron ODTa
	ONDANSETRON ODT-WGRa
	Ondansetron Mylan ODTa
	Ondansetron ODT Viatrisa
	Ondansetron ODT-DRLAa
	Ondansetron SZ ODTa
	Zotren ODTa

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5967CMP	ONDANSETRON ondansetron 4 mg tablet, 4 (PI, CMI)	1	4	0	$3.50	$4.95	$4.95
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 4a

Source	Section 100 (CT)
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
5968DMP	ONDANSETRON ondansetron 8 mg tablet, 4 (PI, CMI)	1	4	0	$4.33	$5.78	$5.78
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 8a

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
8224WMPNP	ONDANSETRON ondansetron 4 mg tablet, 4 (PI, CMI)	1	4	0	$17.37	$18.82	$22.27
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 4a

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
8225XMPNP	ONDANSETRON ondansetron 8 mg tablet, 4 (PI, CMI)	1	4	0	$18.20	$19.65	$23.10
	Available brands
	APO-Ondansetrona
	APX-Ondansetrona
	ONDANSETRON-WGRa
	Ondansetron Mylan Tabletsa
	Ondansetron SZa
	Ondansetron Tablets Viatrisa
	Ondansetron-DRLAa
	Zofrana
	Zotren 8a

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
8233HMPNP	ONDANSETRON ondansetron 4 mg/5 mL oral liquid, 50 mL (PI, CMI)	1	1	1	$100.31	$31.60	$31.60
	Available brands
	Zofran syrup 50 mL

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
8412RMPNP	ONDANSETRON ondansetron 4 mg wafer, 10 (PI, CMI)
	Available brands
	Zofran Zydisa * Additional charge for this brand is $3.46B	1	10	1	$26.33	$24.32	$31.23

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

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
8413TMPNP	ONDANSETRON ondansetron 8 mg wafer, 10 (PI, CMI)
	Available brands
	Zofran Zydisa * Additional charge for this brand is $3.45B	1	10	1	$31.30	$29.30	$35.05

Source	General Schedule
Body System	ALIMENTARY TRACT AND METABOLISM > ANTIEMETICS AND ANTINAUSEANTS > ANTIEMETICS AND ANTINAUSEANTS

Restricted Benefit

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
9441XMPNP	ONDANSETRON ondansetron 4 mg/5 mL oral liquid, 50 mL (PI, CMI)	1	1	0	$100.31	$31.60	$31.60
	Available brands
	Zofran syrup 50 mL