DILTIAZEM
Manner of administration:Oral
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 |
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DPMQ: $21.23 | Max safety net: $21.07 | General Patient Charge: $25.50 | ||
Manner of administration:Oral
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: $21.63 | Max safety net: $23.11 | General Patient Charge: $25.00 |
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DPMQ: $23.27 | Max safety net: $23.11 | General Patient Charge: $26.64 | ||
Manner of administration:Oral
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 90 | # of repeats: 5 | DPMQ: $21.75 | Max safety net: $23.23 | General Patient Charge: $25.00 |
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DPMQ: $23.65 | Max safety net: $23.23 | General Patient Charge: $26.90 | ||
Manner of administration:Oral
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: 180 | # of repeats: 5 | DPMQ: $29.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $33.52 | Max safety net: $25.00 | General Patient Charge: $28.80 | ||
Manner of administration:Oral
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: $29.48 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $32.76 | Max safety net: $25.00 | General Patient Charge: $28.28 | ||
Manner of administration:Oral
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 |
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DPMQ: $28.68 | Max safety net: $25.00 | General Patient Charge: $28.28 | ||
Manner of administration:Oral
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: $37.62 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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DPMQ: $41.42 | Max safety net: $25.00 | General Patient Charge: $28.80 | ||
Manner of administration:Oral
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: $25.70 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $27.60 | Max safety net: $25.00 | General Patient Charge: $26.90 | ||