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: $27.87 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 $2.91
 DPMQ: $30.78 Max safety net: $25.00 General Patient Charge: $27.91

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: $25.13 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 $2.16
 DPMQ: $27.29 Max safety net: $25.00 General Patient Charge: $27.16

EZETIMIBE + ATORVASTATIN (10392Y)

ezetimibe 10 mg + atorvastatin 10 mg tablet, 30
10392Y
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: $22.67 Max safety net: $24.21 General Patient Charge: $25.00
Available brands
Atozet
Ezetast
Ezetimibe/Atorvastatin GH 10/10

EZETIMIBE + ATORVASTATIN (10393B)

ezetimibe 10 mg + atorvastatin 20 mg tablet, 30
10393B
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: $23.22 Max safety net: $24.76 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/20
Atozet
*Additional charge for this brand is $2.13
 DPMQ: $25.35 Max safety net: $24.76 General Patient Charge: $27.13

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: $35.90 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 $4.32
 DPMQ: $40.22 Max safety net: $25.00 General Patient Charge: $29.32

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: $41.38 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 $5.82
 DPMQ: $47.20 Max safety net: $25.00 General Patient Charge: $30.82

EZETIMIBE + ATORVASTATIN (13539N)

ezetimibe 10 mg + atorvastatin 10 mg tablet, 30
13539N
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: $30.98 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Atozet
Ezetast
Ezetimibe/Atorvastatin GH 10/10

EZETIMIBE + ATORVASTATIN (13622Y)

ezetimibe 10 mg + atorvastatin 20 mg tablet, 30
13622Y
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: $32.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/20
Atozet
*Additional charge for this brand is $4.26
 DPMQ: $36.34 Max safety net: $25.00 General Patient Charge: $29.26