DOXYCYCLINE

DOXYCYCLINE (10781K)

doxycycline 100 mg tablet, 7
10781K
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: $25.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (14511R)

doxycycline 100 mg tablet, 7
14511R
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: $36.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (5082L)

doxycycline 100 mg tablet, 7
5082L
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (9105F)

doxycycline 100 mg tablet, 7
9105F
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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (9107H)

doxycycline 100 mg tablet, 7
9107H
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: $25.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz

DOXYCYCLINE (9108J)

doxycycline 100 mg tablet, 7
9108J
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: 3 Max qty units: 21 # of repeats: 0 DPMQ: $22.59 Max safety net: $24.13 General Patient Charge: $25.00
Available brands
Blooms The Chemist Doxycycline
Doxycycline Sandoz