DILTIAZEM

DILTIAZEM (1335G)

diltiazem hydrochloride 60 mg tablet, 90
1335G
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: 90 # of repeats: 5 DPMQ: $21.75 Max safety net: $23.23 General Patient Charge: $25.00
Available brands
Vasocardol
Cardizem
*Additional charge for this brand is $1.90
 DPMQ: $23.65 Max safety net: $23.23 General Patient Charge: $26.90

DILTIAZEM (14479C)

diltiazem hydrochloride 60 mg tablet, 90
14479C
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: 180 # of repeats: 5 DPMQ: $29.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vasocardol
Cardizem
*Additional charge for this brand is $3.80
 DPMQ: $33.52 Max safety net: $25.00 General Patient Charge: $28.80