SAXAGLIPTIN + METFORMIN

SAXAGLIPTIN + METFORMIN (10048W)

saxagliptin 2.5 mg + metformin hydrochloride 1 g modified release tablet, 56
10048W
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15276)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $55.09 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kombiglyze XR 2.5/1000

SAXAGLIPTIN + METFORMIN (10051B)

saxagliptin 5 mg + metformin hydrochloride 1 g modified release tablet, 28
10051B
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15276)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $53.87 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kombiglyze XR 5/1000

SAXAGLIPTIN + METFORMIN (10055F)

saxagliptin 5 mg + metformin hydrochloride 500 mg modified release tablet, 28
10055F
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15276)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $53.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kombiglyze XR 5/500

SAXAGLIPTIN + METFORMIN (13876H)

saxagliptin 5 mg + metformin hydrochloride 1 g modified release tablet, 28
13876H
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15288)

Indication: Diabetes mellitus type 2
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: $93.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kombiglyze XR 5/1000

SAXAGLIPTIN + METFORMIN (13880M)

saxagliptin 2.5 mg + metformin hydrochloride 1 g modified release tablet, 56
13880M
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15288)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $96.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kombiglyze XR 2.5/1000

SAXAGLIPTIN + METFORMIN (14030K)

saxagliptin 5 mg + metformin hydrochloride 500 mg modified release tablet, 28
14030K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15288)

Indication: Diabetes mellitus type 2
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: $92.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kombiglyze XR 5/500