EZETIMIBE (&) ROSUVASTATIN
ezetimibe 10 mg tablet [30] (&) rosuvastatin 20 mg tablet [30], 60
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $28.71 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $31.69 | Max safety net: $25.00 | General Patient Charge: $27.98 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 5 mg tablet [30], 60
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $25.35 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $28.22 | Max safety net: $25.00 | General Patient Charge: $27.87 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 40 mg tablet [30], 60
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $28.40 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $31.49 | Max safety net: $25.00 | General Patient Charge: $28.09 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 10 mg tablet [30], 60
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $26.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $29.71 | Max safety net: $25.00 | General Patient Charge: $27.97 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 20 mg tablet [30], 60
Manner of administration:Oral
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: 2 | # of repeats: 5 | DPMQ: $43.64 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $49.60 | Max safety net: $25.00 | General Patient Charge: $30.96 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 40 mg tablet [30], 60
Manner of administration:Oral
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: 2 | # of repeats: 5 | DPMQ: $43.02 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $49.20 | Max safety net: $25.00 | General Patient Charge: $31.18 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 10 mg tablet [30], 60
Manner of administration:Oral
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: 2 | # of repeats: 5 | DPMQ: $39.70 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $45.64 | Max safety net: $25.00 | General Patient Charge: $30.94 | ||
ezetimibe 10 mg tablet [30] (&) rosuvastatin 5 mg tablet [30], 60
Manner of administration:Oral
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: 2 | # of repeats: 5 | DPMQ: $36.92 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $42.66 | Max safety net: $25.00 | General Patient Charge: $30.74 | ||