DOXYCYCLINE

DOXYCYCLINE (10777F)

doxycycline 100 mg modified release capsule, 7
10777F
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $11.00
 DPMQ: $36.32 Max safety net: $25.00 General Patient Charge: $36.00
Mayne Pharma Doxycycline
*Additional charge for this brand is $5.72
 DPMQ: $31.04 Max safety net: $25.00 General Patient Charge: $30.72

DOXYCYCLINE (14443E)

doxycycline 100 mg modified release capsule, 7
14443E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 8 Max qty units: 56 # of repeats: 2 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $22.00
 DPMQ: $58.28 Max safety net: $25.00 General Patient Charge: $47.00
Mayne Pharma Doxycycline
*Additional charge for this brand is $11.44
 DPMQ: $47.72 Max safety net: $25.00 General Patient Charge: $36.44

DOXYCYCLINE (14484H)

doxycycline 50 mg modified release capsule, 25
14484H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Bronchiectasis

Restriction

Indication: Chronic bronchitis

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 50 # of repeats: 2 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $9.48
 DPMQ: $29.66 Max safety net: $21.72 General Patient Charge: $33.99
Mayne Pharma Doxycycline
*Additional charge for this brand is $4.82
 DPMQ: $25.00 Max safety net: $21.72 General Patient Charge: $29.33

DOXYCYCLINE (2703G)

doxycycline 100 mg modified release capsule, 7
2703G
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Pelvic inflammatory disease
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 28 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $11.00
 DPMQ: $36.32 Max safety net: $25.00 General Patient Charge: $36.00
Mayne Pharma Doxycycline
*Additional charge for this brand is $5.72
 DPMQ: $31.04 Max safety net: $25.00 General Patient Charge: $30.72

DOXYCYCLINE (2707L)

doxycycline 50 mg modified release capsule, 25
2707L
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Bronchiectasis

Restriction

Indication: Chronic bronchitis

Restriction

Indication: Severe acne
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 25 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $4.74
 DPMQ: $22.01 Max safety net: $18.81 General Patient Charge: $26.34
Mayne Pharma Doxycycline
*Additional charge for this brand is $2.41
 DPMQ: $19.68 Max safety net: $18.81 General Patient Charge: $24.01

DOXYCYCLINE (2708M)

doxycycline 100 mg modified release capsule, 7
2708M
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 7 # of repeats: 1 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $2.75
 DPMQ: $19.85 Max safety net: $18.64 General Patient Charge: $24.18
Mayne Pharma Doxycycline
*Additional charge for this brand is $1.43
 DPMQ: $18.53 Max safety net: $18.64 General Patient Charge: $22.86

DOXYCYCLINE (2715X)

doxycycline 100 mg modified release capsule, 21
2715X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Urethritis
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 21 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Mayne Pharma Doxycycline
*Additional charge for this brand is $3.12
 DPMQ: $25.30 Max safety net: $23.72 General Patient Charge: $28.12

DOXYCYCLINE (3322W)

doxycycline 100 mg modified release capsule, 7
3322W
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 7 # of repeats: 0 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Doryx
*Additional charge for this brand is $2.75
 DPMQ: $19.85 Max safety net: $18.64 General Patient Charge: $24.18
Mayne Pharma Doxycycline
*Additional charge for this brand is $1.43
 DPMQ: $18.53 Max safety net: $18.64 General Patient Charge: $22.86