DAPAGLIFLOZIN + METFORMIN

DAPAGLIFLOZIN + METFORMIN (10510E)

dapagliflozin 5 mg + metformin hydrochloride 1 g modified release tablet, 56
10510E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16158)

Indication: Diabetes mellitus type 2

Restriction (Streamlined authority code: 15289)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $54.98 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xigduo XR 5/1000

DAPAGLIFLOZIN + METFORMIN (13851B)

dapagliflozin 5 mg + metformin hydrochloride 1 g modified release tablet, 56
13851B
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16162)

Indication: Diabetes mellitus type 2

Restriction (Streamlined authority code: 15267)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $96.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xigduo XR 5/1000