OLMESARTAN

OLMESARTAN (13505T)

olmesartan medoxomil 20 mg tablet, 30
13505T
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: $22.50 Max safety net: $24.04 General Patient Charge: $25.00
Available brands
APO-Olmesartan
APX-Olmesartan
Blooms The Chemist Olmesartan
OLMERTAN
OLMESARTAN-WGR
Olmesartan - MYL
Olmesartan Sandoz
Olsetan
Pharmacor Olmesartan 20
Olmetec
*Additional charge for this brand is $7.60
 DPMQ: $30.10 Max safety net: $24.04 General Patient Charge: $32.60

OLMESARTAN (13533G)

olmesartan medoxomil 40 mg tablet, 30
13533G
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: $26.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Olmesartan
APX-Olmesartan
Blooms The Chemist Olmesartan
OLMERTAN
OLMESARTAN-WGR
Olmesartan - MYL
Olmesartan Sandoz
Olsetan
Pharmacor Olmesartan 40
Olmetec
*Additional charge for this brand is $8.74
 DPMQ: $34.92 Max safety net: $25.00 General Patient Charge: $33.74

OLMESARTAN (2147B)

olmesartan medoxomil 20 mg tablet, 30
2147B
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: $18.43 Max safety net: $19.97 General Patient Charge: $22.76
Available brands
APO-Olmesartan
APX-Olmesartan
Blooms The Chemist Olmesartan
OLMERTAN
OLMESARTAN-WGR
Olmesartan - MYL
Olmesartan Sandoz
Olsetan
Pharmacor Olmesartan 20
Olmetec
*Additional charge for this brand is $3.80
 DPMQ: $22.23 Max safety net: $19.97 General Patient Charge: $26.56

OLMESARTAN (2148C)

olmesartan medoxomil 40 mg tablet, 30
2148C
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: $20.27 Max safety net: $21.81 General Patient Charge: $24.60
Available brands
APO-Olmesartan
APX-Olmesartan
Blooms The Chemist Olmesartan
OLMERTAN
OLMESARTAN-WGR
Olmesartan - MYL
Olmesartan Sandoz
Olsetan
Pharmacor Olmesartan 40
Olmetec
*Additional charge for this brand is $4.37
 DPMQ: $24.64 Max safety net: $21.81 General Patient Charge: $28.97