EZETIMIBE + ATORVASTATIN

EZETIMIBE + ATORVASTATIN (10376D)

ezetimibe 10 mg + atorvastatin 80 mg tablet, 30
10376D
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 5 DPMQ: $27.71 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/80
Atozet
*Additional charge for this brand is $3.00
 DPMQ: $30.71 Max safety net: $25.00 General Patient Charge: $28.00

EZETIMIBE + ATORVASTATIN (13538M)

ezetimibe 10 mg + atorvastatin 80 mg tablet, 30
13538M
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: $41.64 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/80
Atozet
*Additional charge for this brand is $6.00
 DPMQ: $47.64 Max safety net: $25.00 General Patient Charge: $31.00