LERCANIDIPINE

LERCANIDIPINE (13411W)

lercanidipine hydrochloride 10 mg tablet, 28
13411W
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: 56 # of repeats: 5 DPMQ: $19.22 Max safety net: $20.70 General Patient Charge: $23.49
Available brands
ARX-LERCANIDIPINE
LERCANIDIPINE-WGR
Lercan
Zircol 10
Zanidip
*Additional charge for this brand is $6.96
 DPMQ: $26.18 Max safety net: $20.70 General Patient Charge: $30.45

LERCANIDIPINE (13412X)

lercanidipine hydrochloride 20 mg tablet, 28
13412X
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: 56 # of repeats: 5 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
ARX-LERCANIDIPINE
LERCANIDIPINE-WGR
Lercan
Zircol 20
Zanidip
*Additional charge for this brand is $7.00
 DPMQ: $28.32 Max safety net: $22.80 General Patient Charge: $32.00

LERCANIDIPINE (8534E)

lercanidipine hydrochloride 10 mg tablet, 28
8534E
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: 28 # of repeats: 5 DPMQ: $16.50 Max safety net: $17.98 General Patient Charge: $20.77
Available brands
ARX-LERCANIDIPINE
LERCANIDIPINE-WGR
Lercan
Zircol 10
Zanidip
*Additional charge for this brand is $3.48
 DPMQ: $19.98 Max safety net: $17.98 General Patient Charge: $24.25

LERCANIDIPINE (8679T)

lercanidipine hydrochloride 20 mg tablet, 28
8679T
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: 28 # of repeats: 5 DPMQ: $17.55 Max safety net: $19.03 General Patient Charge: $21.82
Available brands
ARX-LERCANIDIPINE
LERCANIDIPINE-WGR
Lercan
Zircol 20
Zanidip
*Additional charge for this brand is $3.50
 DPMQ: $21.05 Max safety net: $19.03 General Patient Charge: $25.32