BISOPROLOL

bisoprolol fumarate 5 mg tablet, 28

BISOPROLOL (13443M)

bisoprolol fumarate 5 mg tablet, 28
13443M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $22.84 Max safety net: $24.38 General Patient Charge: $25.00
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 5
Bicor
*Additional charge for this brand is $8.36
 DPMQ: $31.20 Max safety net: $24.38 General Patient Charge: $33.36