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: $22.84 Max safety net: $24.38 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 $10.54
 DPMQ: $33.38 Max safety net: $24.38 General Patient Charge: $35.54

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: $22.84 Max safety net: $24.38 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 $8.36
 DPMQ: $31.20 Max safety net: $24.38 General Patient Charge: $33.36

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: $23.64 Max safety net: $25.00 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 $7.38
 DPMQ: $31.02 Max safety net: $25.00 General Patient Charge: $32.38

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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 2.5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 2.5
Bicor
*Additional charge for this brand is $5.27
 DPMQ: $23.87 Max safety net: $20.14 General Patient Charge: $28.20

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: $18.60 Max safety net: $20.14 General Patient Charge: $22.93
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 5
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 5
Bicor
*Additional charge for this brand is $4.18
 DPMQ: $22.78 Max safety net: $20.14 General Patient Charge: $27.11

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: $19.00 Max safety net: $20.54 General Patient Charge: $23.33
Available brands
APO-Bisoprolol
BISOPROLOL-WGR
Bicard 10
Bisoprolol Sandoz
Bisoprolol generichealth
Bispro 10
Bicor
*Additional charge for this brand is $3.69
 DPMQ: $22.69 Max safety net: $20.54 General Patient Charge: $27.02