PRAVASTATIN

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 (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