EZETIMIBE + ATORVASTATIN

EZETIMIBE + ATORVASTATIN (10377E)

ezetimibe 10 mg + atorvastatin 40 mg tablet, 30
10377E
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: $24.90 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/40
Atozet
*Additional charge for this brand is $2.22
 DPMQ: $27.12 Max safety net: $25.00 General Patient Charge: $27.22

EZETIMIBE + ATORVASTATIN (13416D)

ezetimibe 10 mg + atorvastatin 40 mg tablet, 30
13416D
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: $36.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/40
Atozet
*Additional charge for this brand is $4.44
 DPMQ: $40.46 Max safety net: $25.00 General Patient Charge: $29.44