ENALAPRIL + HYDROCHLOROTHIAZIDE

ENALAPRIL + HYDROCHLOROTHIAZIDE (13439H)

enalapril maleate 20 mg + hydrochlorothiazide 6 mg tablet, 30
13439H
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: $22.86 Max safety net: $24.34 General Patient Charge: $25.00
Available brands
Enalapril/HCT Sandoz
Renitec Plus 20/6
*Additional charge for this brand is $13.92
 DPMQ: $36.78 Max safety net: $24.34 General Patient Charge: $38.92

ENALAPRIL + HYDROCHLOROTHIAZIDE (8477E)

enalapril maleate 20 mg + hydrochlorothiazide 6 mg tablet, 30
8477E
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: $18.32 Max safety net: $19.80 General Patient Charge: $22.59
Available brands
Enalapril/HCT Sandoz
Renitec Plus 20/6
*Additional charge for this brand is $6.96
 DPMQ: $25.28 Max safety net: $19.80 General Patient Charge: $29.55