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: $21.84 Max safety net: $23.38 General Patient Charge: $25.00
Available brands
Spironolactone Viatris 25
Aldactone
*Additional charge for this brand is $14.66
 DPMQ: $36.50 Max safety net: $23.38 General Patient Charge: $39.66
Spiractin 25
*Additional charge for this brand is $8.84
 DPMQ: $30.68 Max safety net: $23.38 General Patient Charge: $33.84

SPIRONOLACTONE (14042C)

spironolactone 100 mg tablet, 100
14042C
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: $43.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Spironolactone Viatris 100
Aldactone
*Additional charge for this brand is $14.56
 DPMQ: $57.64 Max safety net: $25.00 General Patient Charge: $39.56
Spiractin 100
*Additional charge for this brand is $8.74
 DPMQ: $51.82 Max safety net: $25.00 General Patient Charge: $33.74

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: $18.10 Max safety net: $19.64 General Patient Charge: $22.43
Available brands
Spironolactone Viatris 25
Aldactone
*Additional charge for this brand is $7.33
 DPMQ: $25.43 Max safety net: $19.64 General Patient Charge: $29.76
Spiractin 25
*Additional charge for this brand is $4.42
 DPMQ: $22.52 Max safety net: $19.64 General Patient Charge: $26.85

SPIRONOLACTONE (2340E)

spironolactone 100 mg tablet, 100
2340E
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: $28.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Spironolactone Viatris 100
Aldactone
*Additional charge for this brand is $7.28
 DPMQ: $36.00 Max safety net: $25.00 General Patient Charge: $32.28
Spiractin 100
*Additional charge for this brand is $4.37
 DPMQ: $33.09 Max safety net: $25.00 General Patient Charge: $29.37