DILTIAZEM

DILTIAZEM (14565N)

diltiazem hydrochloride 360 mg modified release capsule, 30
14565N
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: $37.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diltiazem Sandoz CD
Vasocardol CD
Cardizem CD
*Additional charge for this brand is $3.80
 DPMQ: $41.42 Max safety net: $25.00 General Patient Charge: $28.80

DILTIAZEM (8480H)

diltiazem hydrochloride 360 mg modified release capsule, 30
8480H
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: $25.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Diltiazem Sandoz CD
Vasocardol CD
Cardizem CD
*Additional charge for this brand is $1.90
 DPMQ: $27.60 Max safety net: $25.00 General Patient Charge: $26.90