TRANDOLAPRIL

TRANDOLAPRIL (13403K)

trandolapril 2 mg capsule, 28
13403K
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: 56 # of repeats: 5 DPMQ: $23.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dolapril 2
Tranalpha
Trandolapril Viatris
Gopten
*Additional charge for this brand is $6.68
 DPMQ: $30.42 Max safety net: $25.00 General Patient Charge: $31.68

TRANDOLAPRIL (2793B)

trandolapril 2 mg capsule, 28
2793B
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: 28 # of repeats: 5 DPMQ: $19.05 Max safety net: $20.59 General Patient Charge: $23.38
Available brands
Dolapril 2
Tranalpha
Trandolapril Viatris
Gopten
*Additional charge for this brand is $3.34
 DPMQ: $22.39 Max safety net: $20.59 General Patient Charge: $26.72