IRBESARTAN

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

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: $19.22	Max safety net: $20.70	General Patient Charge: $23.49
Available brands
APO-Irbesartan
AVSARTAN
Abisart 150
Blooms Irbesartan
IRBESARTAN-WGR
Irbesartan Sandoz
Avapro *Additional charge for this brand is $8.08			DPMQ: $27.30	Max safety net: $20.70	General Patient Charge: $31.57
Karvea *Additional charge for this brand is $8.08			DPMQ: $27.30	Max safety net: $20.70	General Patient Charge: $31.57

Body System:

Manner of administration:Oral

General Schedule

Restricted Benefit

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: $21.32	Max safety net: $22.80	General Patient Charge: $25.00
Available brands
APO-Irbesartan
AVSARTAN
Abisart 300
Blooms Irbesartan
IRBESARTAN-WGR
Irbesartan Sandoz
Avapro *Additional charge for this brand is $8.08			DPMQ: $29.40	Max safety net: $22.80	General Patient Charge: $33.08
Karvea *Additional charge for this brand is $8.08			DPMQ: $29.40	Max safety net: $22.80	General Patient Charge: $33.08

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: $16.50	Max safety net: $17.98	General Patient Charge: $20.77
Available brands
APO-Irbesartan
AVSARTAN
Abisart 150
Blooms Irbesartan
IRBESARTAN-WGR
Irbesartan Sandoz
Avapro *Additional charge for this brand is $4.04			DPMQ: $20.54	Max safety net: $17.98	General Patient Charge: $24.81
Karvea *Additional charge for this brand is $4.04			DPMQ: $20.54	Max safety net: $17.98	General Patient Charge: $24.81

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: $17.55	Max safety net: $19.03	General Patient Charge: $21.82
Available brands
APO-Irbesartan
AVSARTAN
Abisart 300
Blooms Irbesartan
IRBESARTAN-WGR
Irbesartan Sandoz
Avapro *Additional charge for this brand is $4.04			DPMQ: $21.59	Max safety net: $19.03	General Patient Charge: $25.86
Karvea *Additional charge for this brand is $4.04			DPMQ: $21.59	Max safety net: $19.03	General Patient Charge: $25.86

IRBESARTAN (13380F)