BISOPROLOL

BISOPROLOL (13419G)

bisoprolol fumarate 2.5 mg tablet, 28
13419G
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
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: $22.40 Max safety net: $23.88 General Patient Charge: $25.00
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 2.5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 2.5
Bicor
*Additional charge for this brand is $11.02
 DPMQ: $33.42 Max safety net: $23.88 General Patient Charge: $36.02

BISOPROLOL (13443M)

bisoprolol fumarate 5 mg tablet, 28
13443M
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
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: $22.40 Max safety net: $23.88 General Patient Charge: $25.00
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 5
Bicor
*Additional charge for this brand is $8.76
 DPMQ: $31.16 Max safety net: $23.88 General Patient Charge: $33.76

BISOPROLOL (13444N)

bisoprolol fumarate 10 mg tablet, 28
13444N
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
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: $23.26 Max safety net: $24.74 General Patient Charge: $25.00
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 10
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 10
Bicor
*Additional charge for this brand is $7.72
 DPMQ: $30.98 Max safety net: $24.74 General Patient Charge: $32.72

BISOPROLOL (8604W)

bisoprolol fumarate 2.5 mg tablet, 28
8604W
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
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: $18.09 Max safety net: $19.57 General Patient Charge: $22.36
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 2.5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 2.5
Bicor
*Additional charge for this brand is $5.51
 DPMQ: $23.60 Max safety net: $19.57 General Patient Charge: $27.87

BISOPROLOL (8605X)

bisoprolol fumarate 5 mg tablet, 28
8605X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
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: $18.09 Max safety net: $19.57 General Patient Charge: $22.36
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 5
Bicor
*Additional charge for this brand is $4.38
 DPMQ: $22.47 Max safety net: $19.57 General Patient Charge: $26.74

BISOPROLOL (8606Y)

bisoprolol fumarate 10 mg tablet, 28
8606Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Moderate to severe heart failure
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: $18.52 Max safety net: $20.00 General Patient Charge: $22.79
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 10
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 10
Bicor
*Additional charge for this brand is $3.86
 DPMQ: $22.38 Max safety net: $20.00 General Patient Charge: $26.65