METHOTREXATE

METHOTREXATE (13882P)

methotrexate 50 mg/2 mL injection, 5 x 2 mL vials
13882P
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 10 # of repeats: 5 DPMQ: $68.64 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Methotrexate

METHOTREXATE (14643Q)

methotrexate 10 mg tablet, 10
14643Q
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: 10 # of repeats: 5 DPMQ: $21.85 Max safety net: $23.33 General Patient Charge: $25.00
Available brands
Chexate
Methoblastin

METHOTREXATE (1622J)

methotrexate 2.5 mg tablet, 30
1622J
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: 30 # of repeats: 5 DPMQ: $19.62 Max safety net: $21.10 General Patient Charge: $23.89
Available brands
ARX-Methotrexate
Chexate
Methoblastin

METHOTREXATE (1623K)

methotrexate 10 mg tablet, 50
1623K
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Patients requiring doses greater than 20 mg per week
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 50 # of repeats: 2 DPMQ: $54.11 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Methotrexate
Chexate
Methoblastin

METHOTREXATE (2272N)

methotrexate 10 mg tablet, 15
2272N
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: 15 # of repeats: 3 DPMQ: $25.89 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Methotrexate
Chexate
Methoblastin

METHOTREXATE (2395C)

methotrexate 50 mg/2 mL injection, 5 x 2 mL vials
2395C
Body System:
Manner of administration:Injection
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: 5 # of repeats: 5 DPMQ: $41.21 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Methotrexate

METHOTREXATE (2396D)

methotrexate 5 mg/2 mL injection, 5 x 2 mL vials
2396D
Body System:
Manner of administration:Injection
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: 5 # of repeats: 0 DPMQ: $42.64 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Methotrexate

METHOTREXATE (4502Y)

4502Y
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
No restrictions
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 250 mg # of repeats: 5 DPMA: $116.73 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Methotrexate
(methotrexate 5 mg/2 mL injection, 5 x 2 mL vials)
DBL Methotrexate
(methotrexate 50 mg/2 mL injection, 5 x 2 mL vials)
DBL Methotrexate
(methotrexate 500 mg/20 mL injection, 20 mL vial)
DBL Methotrexate
(methotrexate 1 g/10 mL injection, 10 mL vial)
Methotrexate Accord
(methotrexate 1 g/10 mL injection, 10 mL vial)
Methotrexate Ebewe
(methotrexate 5 g/50 mL injection, 50 mL vial)

METHOTREXATE (4512L)

4512L
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Restricted Benefit

Restriction

Indication: Patients receiving treatment with a high dose regimen
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 20000 mg # of repeats: 0 DPMA: $844.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Methotrexate
(methotrexate 5 mg/2 mL injection, 5 x 2 mL vials)
DBL Methotrexate
(methotrexate 50 mg/2 mL injection, 5 x 2 mL vials)
DBL Methotrexate
(methotrexate 500 mg/20 mL injection, 20 mL vial)
DBL Methotrexate
(methotrexate 1 g/10 mL injection, 10 mL vial)
Methotrexate Accord
(methotrexate 1 g/10 mL injection, 10 mL vial)
Methotrexate Ebewe
(methotrexate 5 g/50 mL injection, 50 mL vial)

METHOTREXATE (7250N)

7250N
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
No restrictions
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 250 mg # of repeats: 5 DPMA: $162.75 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DBL Methotrexate
(methotrexate 5 mg/2 mL injection, 5 x 2 mL vials)
DBL Methotrexate
(methotrexate 50 mg/2 mL injection, 5 x 2 mL vials)
DBL Methotrexate
(methotrexate 500 mg/20 mL injection, 20 mL vial)
DBL Methotrexate
(methotrexate 1 g/10 mL injection, 10 mL vial)
Methotrexate Accord
(methotrexate 1 g/10 mL injection, 10 mL vial)
Methotrexate Ebewe
(methotrexate 5 g/50 mL injection, 50 mL vial)