FELODIPINE

FELODIPINE (13377C)

felodipine 2.5 mg modified release tablet, 30
13377C
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: $20.48 Max safety net: $21.96 General Patient Charge: $24.75
Available brands
Felodil XR 2.5
Felodur ER 2.5 mg
Plendil ER

FELODIPINE (13531E)

felodipine 10 mg modified release tablet, 30
13531E
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: $28.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Felodil XR 10
Felodur ER 10 mg
Plendil ER
*Additional charge for this brand is $7.50
 DPMQ: $35.90 Max safety net: $25.00 General Patient Charge: $32.50

FELODIPINE (13561R)

felodipine 5 mg modified release tablet, 30
13561R
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: $21.86 Max safety net: $23.34 General Patient Charge: $25.00
Available brands
Felodil XR 5
Felodur ER 5 mg
Plendil ER
*Additional charge for this brand is $7.76
 DPMQ: $29.62 Max safety net: $23.34 General Patient Charge: $32.76

FELODIPINE (2361G)

felodipine 2.5 mg modified release tablet, 30
2361G
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: $17.13 Max safety net: $18.61 General Patient Charge: $21.40
Available brands
Felodil XR 2.5
Felodur ER 2.5 mg
Plendil ER

FELODIPINE (2366M)

felodipine 5 mg modified release tablet, 30
2366M
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: $17.82 Max safety net: $19.30 General Patient Charge: $22.09
Available brands
Felodil XR 5
Felodur ER 5 mg
Plendil ER
*Additional charge for this brand is $3.88
 DPMQ: $21.70 Max safety net: $19.30 General Patient Charge: $25.97

FELODIPINE (2367N)

felodipine 10 mg modified release tablet, 30
2367N
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: $21.09 Max safety net: $22.57 General Patient Charge: $25.00
Available brands
Felodil XR 10
Felodur ER 10 mg
Plendil ER
*Additional charge for this brand is $3.75
 DPMQ: $24.84 Max safety net: $22.57 General Patient Charge: $28.75