OLMESARTAN

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: $26.00 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 $9.00
 DPMQ: $35.00 Max safety net: $25.00 General Patient Charge: $34.00

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: $19.89 Max safety net: $21.37 General Patient Charge: $24.16
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 $4.50
 DPMQ: $24.39 Max safety net: $21.37 General Patient Charge: $28.66