OLMESARTAN + HYDROCHLOROTHIAZIDE

OLMESARTAN + HYDROCHLOROTHIAZIDE (13447R)

olmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30
13447R
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: $22.84 Max safety net: $24.38 General Patient Charge: $25.00
Available brands
APO-Olmesartan/HCTZ 20/12.5
APX-Olmesartan/HCTZ
OLMERTAN COMBI 20/12.5
OLMESARTAN HCTZ-WGR 20/12.5
Olmesartan HCT - MYL 20/12.5
Olmesartan/HCT Sandoz
Pharmacor Olmesartan HCTZ 20/12.5
Olmetec Plus
*Additional charge for this brand is $5.68
 DPMQ: $28.52 Max safety net: $24.38 General Patient Charge: $30.68

OLMESARTAN + HYDROCHLOROTHIAZIDE (2161R)

olmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30
2161R
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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
APO-Olmesartan/HCTZ 20/12.5
APX-Olmesartan/HCTZ
OLMERTAN COMBI 20/12.5
OLMESARTAN HCTZ-WGR 20/12.5
Olmesartan HCT - MYL 20/12.5
Olmesartan/HCT Sandoz
Pharmacor Olmesartan HCTZ 20/12.5
Olmetec Plus
*Additional charge for this brand is $2.84
 DPMQ: $21.44 Max safety net: $20.14 General Patient Charge: $25.77