PROPRANOLOL

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

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: $20.92	Max safety net: $22.40	General Patient Charge: $25.00
Available brands
APO-Propranolol
PROPRANOLOL-WGR
Deralin 40 *Additional charge for this brand is $5.98			DPMQ: $26.90	Max safety net: $22.40	General Patient Charge: $30.98
Inderal *Additional charge for this brand is $16.96			DPMQ: $37.88	Max safety net: $22.40	General Patient Charge: $41.96

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: $17.35	Max safety net: $18.83	General Patient Charge: $21.62
Available brands
APO-Propranolol
PROPRANOLOL-WGR
Deralin 40 *Additional charge for this brand is $2.99			DPMQ: $20.34	Max safety net: $18.83	General Patient Charge: $24.61
Inderal *Additional charge for this brand is $8.48			DPMQ: $25.83	Max safety net: $18.83	General Patient Charge: $30.10

PROPRANOLOL (13542R)