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: $21.06 Max safety net: $22.60 General Patient Charge: $25.00
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: $28.52 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 $7.28
 DPMQ: $35.80 Max safety net: $25.00 General Patient Charge: $32.28

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: $22.34 Max safety net: $23.88 General Patient Charge: $25.00
Available brands
Felodil XR 5
Felodur ER 5 mg
Plendil ER
*Additional charge for this brand is $7.38
 DPMQ: $29.72 Max safety net: $23.88 General Patient Charge: $32.38

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: $17.71 Max safety net: $19.25 General Patient Charge: $22.04
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: $18.35 Max safety net: $19.89 General Patient Charge: $22.68
Available brands
Felodil XR 5
Felodur ER 5 mg
Plendil ER
*Additional charge for this brand is $3.69
 DPMQ: $22.04 Max safety net: $19.89 General Patient Charge: $26.37

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: $21.44 Max safety net: $22.98 General Patient Charge: $25.00
Available brands
Felodil XR 10
Felodur ER 10 mg
Plendil ER
*Additional charge for this brand is $3.64
 DPMQ: $25.08 Max safety net: $22.98 General Patient Charge: $28.64