DAPAGLIFLOZIN + METFORMIN

DAPAGLIFLOZIN + METFORMIN (10516L)

dapagliflozin 10 mg + metformin hydrochloride 500 mg modified release tablet, 28
10516L
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: 28 # of repeats: 5 DPMQ: $52.90 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xigduo XR 10/500

DAPAGLIFLOZIN + METFORMIN (14028H)

dapagliflozin 10 mg + metformin hydrochloride 500 mg modified release tablet, 28
14028H
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: 56 # of repeats: 5 DPMQ: $92.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xigduo XR 10/500