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 |
$55.93 |
$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 |
$57.36 |
$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 |
$55.93 |
$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 |
10677YMPNP |
EMPAGLIFLOZIN + METFORMIN empagliflozin 12.5 mg + metformin hydrochloride 1 g tablet, 60
(PI,
CMI)
|
1 |
60 |
5 |
$57.36 |
$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 |
$101.27 |
$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 |
$98.41 |
$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 |
$101.27 |
$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 |
$98.41 |
$31.60 |
$31.60 |
Available brands |
Jardiamet 5 mg/500 mg |
space
- Legend
- MPMedical Practitioner
- NPNurse Practitioner
- 60D60-day prescriptions