VERAPAMIL

VERAPAMIL (1241H)

verapamil hydrochloride 240 mg modified release tablet, 30
1241H
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: $20.92 Max safety net: $22.40 General Patient Charge: $25.00
Available brands
Cordilox SR
Isoptin SR
*Additional charge for this brand is $3.50
 DPMQ: $24.42 Max safety net: $22.40 General Patient Charge: $28.50

VERAPAMIL (1250T)

verapamil hydrochloride 80 mg tablet, 100
1250T
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: 100 # of repeats: 5 DPMQ: $20.41 Max safety net: $21.89 General Patient Charge: $24.68
Available brands
Anpec 80
Isoptin
*Additional charge for this brand is $3.10
 DPMQ: $23.51 Max safety net: $21.89 General Patient Charge: $27.78

VERAPAMIL (13408Q)

verapamil hydrochloride 240 mg modified release tablet, 30
13408Q
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: $28.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Cordilox SR
Isoptin SR
*Additional charge for this brand is $7.00
 DPMQ: $35.06 Max safety net: $25.00 General Patient Charge: $32.00

VERAPAMIL (13434C)

verapamil hydrochloride 180 mg modified release tablet, 30
13434C
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: $24.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Cordilox 180 SR
Isoptin 180 SR
*Additional charge for this brand is $7.08
 DPMQ: $31.56 Max safety net: $25.00 General Patient Charge: $32.08

VERAPAMIL (13530D)

verapamil hydrochloride 80 mg tablet, 100
13530D
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: 200 # of repeats: 5 DPMQ: $27.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Anpec 80
Isoptin
*Additional charge for this brand is $6.20
 DPMQ: $33.24 Max safety net: $25.00 General Patient Charge: $31.20

VERAPAMIL (2208F)

verapamil hydrochloride 180 mg modified release tablet, 30
2208F
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: $19.13 Max safety net: $20.61 General Patient Charge: $23.40
Available brands
Cordilox 180 SR
Isoptin 180 SR
*Additional charge for this brand is $3.54
 DPMQ: $22.67 Max safety net: $20.61 General Patient Charge: $26.94