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: $19.99 | Max safety net: $21.53 | General Patient Charge: $24.32 |
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DPMQ: $21.58 | Max safety net: $21.53 | General Patient Charge: $25.91 | ||
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: $21.96 | Max safety net: $23.50 | General Patient Charge: $25.00 |
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DPMQ: $23.56 | Max safety net: $23.50 | General Patient Charge: $26.60 | ||
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: $22.08 | Max safety net: $23.62 | General Patient Charge: $25.00 |
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DPMQ: $23.92 | Max safety net: $23.62 | General Patient Charge: $26.84 | ||
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: $29.80 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $33.48 | Max safety net: $25.00 | General Patient Charge: $28.68 | ||
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: $29.56 | 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: $28.20 | ||
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: $25.62 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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DPMQ: $28.80 | Max safety net: $25.00 | General Patient Charge: $28.18 | ||
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: $37.48 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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DPMQ: $41.14 | Max safety net: $25.00 | General Patient Charge: $28.66 | ||
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: $25.92 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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DPMQ: $27.75 | Max safety net: $25.00 | General Patient Charge: $26.83 | ||