ISOSORBIDE MONONITRATE

ISOSORBIDE MONONITRATE (13611J)

isosorbide mononitrate 120 mg modified release tablet, 30
13611J
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: $28.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Monodur 120 mg
Imdur 120 mg
*Additional charge for this brand is $6.74
 DPMQ: $35.18 Max safety net: $25.00 General Patient Charge: $31.74

ISOSORBIDE MONONITRATE (8273K)

isosorbide mononitrate 120 mg modified release tablet, 30
8273K
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: $21.11 Max safety net: $22.59 General Patient Charge: $25.00
Available brands
Monodur 120 mg
Imdur 120 mg
*Additional charge for this brand is $3.37
 DPMQ: $24.48 Max safety net: $22.59 General Patient Charge: $28.37