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: $21.90 Max safety net: $23.44 General Patient Charge: $25.00
Available brands
APX-Pravastatin
Cholstat 40
Lipostat 40
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $9.50
 DPMQ: $31.40 Max safety net: $23.44 General Patient Charge: $34.50

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: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APX-Pravastatin
Lipostat 10
PRAVASTATIN-WGR
Pravastatin Sandoz
Cholstat 10
*Additional charge for this brand is $5.50
 DPMQ: $25.34 Max safety net: $21.38 General Patient Charge: $29.67
Pravachol
*Additional charge for this brand is $9.38
 DPMQ: $29.22 Max safety net: $21.38 General Patient Charge: $33.55

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: $20.38 Max safety net: $21.92 General Patient Charge: $24.71
Available brands
APX-Pravastatin
Cholstat 20
Lipostat 20
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $9.42
 DPMQ: $29.80 Max safety net: $21.92 General Patient Charge: $34.13

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: $25.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Pravastatin
Lipostat 80
Pravachol
*Additional charge for this brand is $9.98
 DPMQ: $35.68 Max safety net: $25.00 General Patient Charge: $34.98

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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APX-Pravastatin
Lipostat 10
PRAVASTATIN-WGR
Pravastatin Sandoz
Cholstat 10
*Additional charge for this brand is $2.75
 DPMQ: $19.85 Max safety net: $18.64 General Patient Charge: $24.18
Pravachol
*Additional charge for this brand is $4.69
 DPMQ: $21.79 Max safety net: $18.64 General Patient Charge: $26.12

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: $17.37 Max safety net: $18.91 General Patient Charge: $21.70
Available brands
APX-Pravastatin
Cholstat 20
Lipostat 20
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $4.71
 DPMQ: $22.08 Max safety net: $18.91 General Patient Charge: $26.41

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: $18.13 Max safety net: $19.67 General Patient Charge: $22.46
Available brands
APX-Pravastatin
Cholstat 40
Lipostat 40
PRAVASTATIN-WGR
Pravastatin Sandoz
Pravachol
*Additional charge for this brand is $4.75
 DPMQ: $22.88 Max safety net: $19.67 General Patient Charge: $27.21

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: $20.03 Max safety net: $21.57 General Patient Charge: $24.36
Available brands
APX-Pravastatin
Lipostat 80
Pravachol
*Additional charge for this brand is $4.99
 DPMQ: $25.02 Max safety net: $21.57 General Patient Charge: $29.35