TELMISARTAN

TELMISARTAN (13437F)

telmisartan 40 mg tablet, 28
13437F
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: 56 # of repeats: 5 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 40
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $20.00
 DPMQ: $39.22 Max safety net: $20.70 General Patient Charge: $43.49

TELMISARTAN (13593K)

telmisartan 80 mg tablet, 28
13593K
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: 56 # of repeats: 5 DPMQ: $22.40 Max safety net: $23.88 General Patient Charge: $25.00
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 80
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $20.00
 DPMQ: $42.40 Max safety net: $23.88 General Patient Charge: $45.00

TELMISARTAN (8355R)

telmisartan 40 mg tablet, 28
8355R
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: 28 # of repeats: 5 DPMQ: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 40
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $10.00
 DPMQ: $26.50 Max safety net: $17.98 General Patient Charge: $30.77

TELMISARTAN (8356T)

telmisartan 80 mg tablet, 28
8356T
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: 28 # of repeats: 5 DPMQ: $18.09 Max safety net: $19.57 General Patient Charge: $22.36
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 80
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $10.00
 DPMQ: $28.09 Max safety net: $19.57 General Patient Charge: $32.36