EMPAGLIFLOZIN + METFORMIN

EMPAGLIFLOZIN + METFORMIN (10633P)

empagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60
10633P
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: 60 # of repeats: 5 DPMQ: $56.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Jardiamet 12.5 mg/500 mg

EMPAGLIFLOZIN + METFORMIN (13903R)

empagliflozin 12.5 mg + metformin hydrochloride 500 mg tablet, 60
13903R
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: 120 # of repeats: 5 DPMQ: $98.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Jardiamet 12.5 mg/500 mg