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: $21.07 Max safety net: $22.61 General Patient Charge: $25.00
Available brands
APX-Sotalol
Cardol
SOTALOL-WGR
Solavert
Sotalol Sandoz
Sotacor
*Additional charge for this brand is $4.84
 DPMQ: $25.91 Max safety net: $22.61 General Patient Charge: $29.84

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: $18.09 Max safety net: $19.63 General Patient Charge: $22.42
Available brands
APX-Sotalol
Cardol
SOTALOL-WGR
Solavert
Sotalol Sandoz
Sotacor
*Additional charge for this brand is $4.50
 DPMQ: $22.59 Max safety net: $19.63 General Patient Charge: $26.92