LISINOPRIL

lisinopril 10 mg tablet, 30

LISINOPRIL (13584Y)

lisinopril 10 mg tablet, 30
13584Y
Body System:
Manner of administration:Oral
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: 60 # of repeats: 5 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
APO-Lisinopril
Fibsol 10
LISINOPRIL-WGR
Lisinopril Sandoz
Zinopril 10
Zestril
*Additional charge for this brand is $9.68
 DPMQ: $31.00 Max safety net: $22.80 General Patient Charge: $34.68