IRBESARTAN + HYDROCHLOROTHIAZIDE

IRBESARTAN + HYDROCHLOROTHIAZIDE (13545X)

irbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30
13545X
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: $21.54 Max safety net: $23.02 General Patient Charge: $25.00
Available brands
APO-Irbesartan HCTZ
AVSARTAN HCT 300/12.5
Abisart HCTZ 300/12.5
IRBESARTAN HCTZ-WGR 300/12.5
Irbesartan/HCT Sandoz
Avapro HCT 300/12.5
*Additional charge for this brand is $8.06
 DPMQ: $29.60 Max safety net: $23.02 General Patient Charge: $33.06
Karvezide 300/12.5
*Additional charge for this brand is $8.06
 DPMQ: $29.60 Max safety net: $23.02 General Patient Charge: $33.06

IRBESARTAN + HYDROCHLOROTHIAZIDE (8405J)

irbesartan 300 mg + hydrochlorothiazide 12.5 mg tablet, 30
8405J
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: $17.66 Max safety net: $19.14 General Patient Charge: $21.93
Available brands
APO-Irbesartan HCTZ
AVSARTAN HCT 300/12.5
Abisart HCTZ 300/12.5
IRBESARTAN HCTZ-WGR 300/12.5
Irbesartan/HCT Sandoz
Avapro HCT 300/12.5
*Additional charge for this brand is $4.03
 DPMQ: $21.69 Max safety net: $19.14 General Patient Charge: $25.96
Karvezide 300/12.5
*Additional charge for this brand is $4.03
 DPMQ: $21.69 Max safety net: $19.14 General Patient Charge: $25.96