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: $22.08 Max safety net: $23.62 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 $7.60
 DPMQ: $29.68 Max safety net: $23.62 General Patient Charge: $32.60

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: $25.96 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 $7.76
 DPMQ: $33.72 Max safety net: $25.00 General Patient Charge: $32.76

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: $25.20 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 $7.72
 DPMQ: $32.92 Max safety net: $25.00 General Patient Charge: $32.72

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: $18.22 Max safety net: $19.76 General Patient Charge: $22.55
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 $3.80
 DPMQ: $22.02 Max safety net: $19.76 General Patient Charge: $26.35

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: $19.78 Max safety net: $21.32 General Patient Charge: $24.11
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 $3.86
 DPMQ: $23.64 Max safety net: $21.32 General Patient Charge: $27.97

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: $20.16 Max safety net: $21.70 General Patient Charge: $24.49
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 $3.88
 DPMQ: $24.04 Max safety net: $21.70 General Patient Charge: $28.37