OLMESARTAN + AMLODIPINE

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 (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