EZETIMIBE + ATORVASTATIN

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: $22.92 Max safety net: $24.40 General Patient Charge: $25.00
Available brands
Ezetast
Ezetimibe/Atorvastatin GH 10/20
Atozet
*Additional charge for this brand is $2.20
 DPMQ: $25.12 Max safety net: $24.40 General Patient Charge: $27.20

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: $32.06 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 $4.40
 DPMQ: $36.46 Max safety net: $25.00 General Patient Charge: $29.40