PRAVASTATIN

PRAVASTATIN (13432Y)

pravastatin sodium 40 mg tablet, 30
13432Y
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: $21.40 Max safety net: $22.88 General Patient Charge: $25.00
Available brands
APX-Pravastatin
Cholstat 40
Lipostat 40
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $9.96
 DPMQ: $31.36 Max safety net: $22.88 General Patient Charge: $34.96

PRAVASTATIN (13496H)

pravastatin sodium 10 mg tablet, 30
13496H
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: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
APX-Pravastatin
Lipostat 10
PRAVASTATIN-WGR
Pravastatin Sandoz
Cholstat 10
*Additional charge for this brand is $5.86
 DPMQ: $25.08 Max safety net: $20.70 General Patient Charge: $29.35
Pravachol
*Additional charge for this brand is $9.90
 DPMQ: $29.12 Max safety net: $20.70 General Patient Charge: $33.39

PRAVASTATIN (13497J)

pravastatin sodium 20 mg tablet, 30
13497J
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: $19.76 Max safety net: $21.24 General Patient Charge: $24.03
Available brands
APX-Pravastatin
Cholstat 20
Lipostat 20
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $9.96
 DPMQ: $29.72 Max safety net: $21.24 General Patient Charge: $33.99

PRAVASTATIN (13527Y)

pravastatin sodium 80 mg tablet, 30
13527Y
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: $25.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Pravastatin
Lipostat 80
Pravachol
*Additional charge for this brand is $10.30
 DPMQ: $35.78 Max safety net: $25.00 General Patient Charge: $35.30

PRAVASTATIN (2833D)

pravastatin sodium 10 mg tablet, 30
2833D
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: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
APX-Pravastatin
Lipostat 10
PRAVASTATIN-WGR
Pravastatin Sandoz
Cholstat 10
*Additional charge for this brand is $2.93
 DPMQ: $19.43 Max safety net: $17.98 General Patient Charge: $23.70
Pravachol
*Additional charge for this brand is $4.95
 DPMQ: $21.45 Max safety net: $17.98 General Patient Charge: $25.72

PRAVASTATIN (2834E)

pravastatin sodium 20 mg tablet, 30
2834E
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: $16.77 Max safety net: $18.25 General Patient Charge: $21.04
Available brands
APX-Pravastatin
Cholstat 20
Lipostat 20
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $4.98
 DPMQ: $21.75 Max safety net: $18.25 General Patient Charge: $26.02

PRAVASTATIN (8197K)

pravastatin sodium 40 mg tablet, 30
8197K
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: $17.59 Max safety net: $19.07 General Patient Charge: $21.86
Available brands
APX-Pravastatin
Cholstat 40
Lipostat 40
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $4.98
 DPMQ: $22.57 Max safety net: $19.07 General Patient Charge: $26.84

PRAVASTATIN (8829Q)

pravastatin sodium 80 mg tablet, 30
8829Q
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: $19.63 Max safety net: $21.11 General Patient Charge: $23.90
Available brands
APX-Pravastatin
Lipostat 80
Pravachol
*Additional charge for this brand is $5.15
 DPMQ: $24.78 Max safety net: $21.11 General Patient Charge: $29.05