SOTALOL

SOTALOL (2043M)

sotalol hydrochloride 160 mg tablet, 60
2043M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe cardiac arrhythmias
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: $20.70 Max safety net: $22.18 General Patient Charge: $24.97
Available brands
APX-Sotalol
Cardol
SOTALOL-WGR
Solavert
Sotalol Sandoz
Sotacor
*Additional charge for this brand is $4.99
 DPMQ: $25.69 Max safety net: $22.18 General Patient Charge: $29.96

SOTALOL (8398B)

sotalol hydrochloride 80 mg tablet, 60
8398B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe cardiac arrhythmias
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: $17.69 Max safety net: $19.17 General Patient Charge: $21.96
Available brands
APX-Sotalol
Cardol
SOTALOL-WGR
Solavert
Sotalol Sandoz
Sotacor
*Additional charge for this brand is $4.58
 DPMQ: $22.27 Max safety net: $19.17 General Patient Charge: $26.54