VILDAGLIPTIN + METFORMIN

VILDAGLIPTIN + METFORMIN (13877J)

vildagliptin 50 mg + metformin hydrochloride 500 mg tablet, 60
13877J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15288)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $68.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Vildagliptin/Metformin 50/500
Galvumet 50/500

VILDAGLIPTIN + METFORMIN (13991J)

vildagliptin 50 mg + metformin hydrochloride 850 mg tablet, 60
13991J
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15288)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $70.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Vildagliptin/Metformin 50/850
Galvumet 50/850

VILDAGLIPTIN + METFORMIN (14032M)

vildagliptin 50 mg + metformin hydrochloride 1 g tablet, 60
14032M
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15288)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 5 DPMQ: $70.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Vildagliptin/Metformin 50/1000
Galvumet 50/1000

VILDAGLIPTIN + METFORMIN (5474D)

vildagliptin 50 mg + metformin hydrochloride 500 mg tablet, 60
5474D
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15276)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $41.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Vildagliptin/Metformin 50/500
Galvumet 50/500

VILDAGLIPTIN + METFORMIN (5475E)

vildagliptin 50 mg + metformin hydrochloride 850 mg tablet, 60
5475E
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15276)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $41.92 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Vildagliptin/Metformin 50/850
Galvumet 50/850

VILDAGLIPTIN + METFORMIN (5476F)

vildagliptin 50 mg + metformin hydrochloride 1 g tablet, 60
5476F
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15276)

Indication: Diabetes mellitus type 2
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $42.25 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Vildagliptin/Metformin 50/1000
Galvumet 50/1000