SPIRONOLACTONE

SPIRONOLACTONE (13503Q)

spironolactone 25 mg tablet, 100
13503Q
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: 200 # of repeats: 5 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
Spironolactone Viatris 25
Aldactone
*Additional charge for this brand is $15.30
 DPMQ: $36.62 Max safety net: $22.80 General Patient Charge: $40.30
Spiractin 25
*Additional charge for this brand is $9.30
 DPMQ: $30.62 Max safety net: $22.80 General Patient Charge: $34.30

SPIRONOLACTONE (2339D)

spironolactone 25 mg tablet, 100
2339D
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: 100 # of repeats: 5 DPMQ: $17.55 Max safety net: $19.03 General Patient Charge: $21.82
Available brands
Spironolactone Viatris 25
Aldactone
*Additional charge for this brand is $7.65
 DPMQ: $25.20 Max safety net: $19.03 General Patient Charge: $29.47
Spiractin 25
*Additional charge for this brand is $4.65
 DPMQ: $22.20 Max safety net: $19.03 General Patient Charge: $26.47