VERAPAMIL

VERAPAMIL (1241H)

verapamil hydrochloride 240 mg modified release tablet, 30
1241H
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: $21.28 Max safety net: $22.82 General Patient Charge: $25.00
Available brands
Cordilox SR
Isoptin SR
*Additional charge for this brand is $3.40
 DPMQ: $24.68 Max safety net: $22.82 General Patient Charge: $28.40

VERAPAMIL (13408Q)

verapamil hydrochloride 240 mg modified release tablet, 30
13408Q
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: $28.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Cordilox SR
Isoptin SR
*Additional charge for this brand is $6.80
 DPMQ: $35.00 Max safety net: $25.00 General Patient Charge: $31.80

VERAPAMIL (13434C)

verapamil hydrochloride 180 mg modified release tablet, 30
13434C
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: $24.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Cordilox 180 SR
Isoptin 180 SR
*Additional charge for this brand is $6.82
 DPMQ: $31.60 Max safety net: $25.00 General Patient Charge: $31.82

VERAPAMIL (2208F)

verapamil hydrochloride 180 mg modified release tablet, 30
2208F
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: $19.57 Max safety net: $21.11 General Patient Charge: $23.90
Available brands
Cordilox 180 SR
Isoptin 180 SR
*Additional charge for this brand is $3.41
 DPMQ: $22.98 Max safety net: $21.11 General Patient Charge: $27.31