SPIRONOLACTONE

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: $43.42 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Spironolactone Viatris 100
Aldactone
*Additional charge for this brand is $15.00
 DPMQ: $58.42 Max safety net: $25.00 General Patient Charge: $40.00
Spiractin 100
*Additional charge for this brand is $9.00
 DPMQ: $52.42 Max safety net: $25.00 General Patient Charge: $34.00

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: $28.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Spironolactone Viatris 100
Aldactone
*Additional charge for this brand is $7.50
 DPMQ: $36.10 Max safety net: $25.00 General Patient Charge: $32.50
Spiractin 100
*Additional charge for this brand is $4.50
 DPMQ: $33.10 Max safety net: $25.00 General Patient Charge: $29.50