EMPAGLIFLOZIN + METFORMIN
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 |
10626GMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 5 mg + metformin hydrochloride 500 mg tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$62.61 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/500 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10627HMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$64.13 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/1000 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10633PMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$62.61 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 12.5 mg/500 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10639YMP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$62.61 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 12.5 mg/500 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10640BMP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$64.13 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 12.5 mg/1000 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10649LMP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$64.13 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/1000 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10650MMP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 5 mg + metformin hydrochloride 500 mg tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$62.61 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/500 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
10677YMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$64.13 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 12.5 mg/1000 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
13852CMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
2 |
120 |
5 |
$115.39 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/1000 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
13903RMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60
(PI,
CMI)
|
2 |
120 |
5 |
$112.23 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 12.5 mg/500 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
13987EMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
2 |
120 |
5 |
$115.39 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 12.5 mg/1000 mg |
space
EMPAGLIFLOZIN + METFORMIN
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 |
14029JMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 5 mg + metformin hydrochloride 500 mg tablet, 60
(PI,
CMI)
|
2 |
120 |
5 |
$112.23 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/500 mg |
space
- Legend
- MPMedical Practitioner
- NPNurse Practitioner