DILTIAZEM

DILTIAZEM (1312C)

diltiazem hydrochloride 180 mg modified release capsule, 30
1312C
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: $19.59 Max safety net: $21.07 General Patient Charge: $23.86
Available brands
Diltiazem Sandoz CD
Vasocardol CD
Cardizem CD
*Additional charge for this brand is $1.64
 DPMQ: $21.23 Max safety net: $21.07 General Patient Charge: $25.50

DILTIAZEM (14564M)

diltiazem hydrochloride 180 mg modified release capsule, 30
14564M
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: $25.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diltiazem Sandoz CD
Vasocardol CD
Cardizem CD
*Additional charge for this brand is $3.28
 DPMQ: $28.68 Max safety net: $25.00 General Patient Charge: $28.28