OLMESARTAN + AMLODIPINE

OLMESARTAN + AMLODIPINE (13449W)

olmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30
13449W
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: $21.58 Max safety net: $23.06 General Patient Charge: $25.00
Available brands
APO-OLMESARTAN/AMLODIPINE 20/5
OLMEKAR
OLMESARTAN AMLODIPINE-WGR 20/5
Olmesartan/Amlodipine - MYL 20/5
Olmesartan/Amlodipine Sandoz
Pharmacor Olmesartan Amlodipine 20/5
Sevikar 20/5
*Additional charge for this brand is $8.00
 DPMQ: $29.58 Max safety net: $23.06 General Patient Charge: $33.00

OLMESARTAN + AMLODIPINE (13943W)

olmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30
13943W
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: $25.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-OLMESARTAN/AMLODIPINE 40/10
OLMEKAR
OLMESARTAN AMLODIPINE-WGR 40/10
Olmesartan/Amlodipine - MYL 40/10
Olmesartan/Amlodipine Sandoz
Pharmacor Olmesartan Amlodipine 40/10
Sevikar 40/10
*Additional charge for this brand is $8.00
 DPMQ: $33.76 Max safety net: $25.00 General Patient Charge: $33.00

OLMESARTAN + AMLODIPINE (13964Y)

olmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30
13964Y
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: $24.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-OLMESARTAN/AMLODIPINE 40/5
OLMEKAR
OLMESARTAN AMLODIPINE-WGR 40/5
Olmesartan/Amlodipine - MYL 40/5
Olmesartan/Amlodipine Sandoz
Pharmacor Olmesartan Amlodipine 40/5
Sevikar 40/5
*Additional charge for this brand is $8.00
 DPMQ: $32.94 Max safety net: $25.00 General Patient Charge: $33.00

OLMESARTAN + AMLODIPINE (5292M)

olmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30
5292M
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: $17.68 Max safety net: $19.16 General Patient Charge: $21.95
Available brands
APO-OLMESARTAN/AMLODIPINE 20/5
OLMEKAR
OLMESARTAN AMLODIPINE-WGR 20/5
Olmesartan/Amlodipine - MYL 20/5
Olmesartan/Amlodipine Sandoz
Pharmacor Olmesartan Amlodipine 20/5
Sevikar 20/5
*Additional charge for this brand is $4.00
 DPMQ: $21.68 Max safety net: $19.16 General Patient Charge: $25.95

OLMESARTAN + AMLODIPINE (5293N)

olmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30
5293N
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: $19.36 Max safety net: $20.84 General Patient Charge: $23.63
Available brands
APO-OLMESARTAN/AMLODIPINE 40/5
OLMEKAR
OLMESARTAN AMLODIPINE-WGR 40/5
Olmesartan/Amlodipine - MYL 40/5
Olmesartan/Amlodipine Sandoz
Pharmacor Olmesartan Amlodipine 40/5
Sevikar 40/5
*Additional charge for this brand is $4.00
 DPMQ: $23.36 Max safety net: $20.84 General Patient Charge: $27.63

OLMESARTAN + AMLODIPINE (5294P)

olmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30
5294P
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: $19.77 Max safety net: $21.25 General Patient Charge: $24.04
Available brands
APO-OLMESARTAN/AMLODIPINE 40/10
OLMEKAR
OLMESARTAN AMLODIPINE-WGR 40/10
Olmesartan/Amlodipine - MYL 40/10
Olmesartan/Amlodipine Sandoz
Pharmacor Olmesartan Amlodipine 40/10
Sevikar 40/10
*Additional charge for this brand is $4.00
 DPMQ: $23.77 Max safety net: $21.25 General Patient Charge: $28.04