GLICLAZIDE

GLICLAZIDE (13922R)

gliclazide 60 mg modified release tablet, 60
13922R
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: 120 # of repeats: 5 DPMQ: $22.22 Max safety net: $23.70 General Patient Charge: $25.00
Available brands
ARDIX GLICLAZIDE 60mg MR
Gliclazide Lupin MR
Gliclazide Sandoz MR
Pharmacor Gliclazide MR
Diamicron 60mg MR
*Additional charge for this brand is $19.90
 DPMQ: $42.12 Max safety net: $23.70 General Patient Charge: $44.90