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: $19.84 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 40
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $19.18
 DPMQ: $39.02 Max safety net: $21.38 General Patient Charge: $43.35

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: $22.84 Max safety net: $24.38 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 $19.26
 DPMQ: $42.10 Max safety net: $24.38 General Patient Charge: $44.26

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: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 40
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $9.59
 DPMQ: $26.69 Max safety net: $18.64 General Patient Charge: $31.02

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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
APO-Telmisartan
Mizart
Pharmacor Telmisartan 80
TELMISARTAN-WGR
Telmisartan Sandoz
Teltartan
Micardis
*Additional charge for this brand is $9.63
 DPMQ: $28.23 Max safety net: $20.14 General Patient Charge: $32.56