TELMISARTAN + HYDROCHLOROTHIAZIDE

TELMISARTAN + HYDROCHLOROTHIAZIDE (13546Y)

telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28
13546Y
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: $20.08 Max safety net: $21.62 General Patient Charge: $24.41
Available brands
APO-Telmisartan HCTZ 40/12.5
Mizart HCT 40/12.5 mg
TELMISARTAN HCTZ-WGR 40/12.5
Telmisartan/HCT Sandoz
Teltartan HCT 40/12.5
Micardis Plus 40/12.5 mg
*Additional charge for this brand is $19.16
 DPMQ: $39.24 Max safety net: $21.62 General Patient Charge: $43.57

TELMISARTAN + HYDROCHLOROTHIAZIDE (8622T)

telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28
8622T
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: $17.22 Max safety net: $18.76 General Patient Charge: $21.55
Available brands
APO-Telmisartan HCTZ 40/12.5
Mizart HCT 40/12.5 mg
TELMISARTAN HCTZ-WGR 40/12.5
Telmisartan/HCT Sandoz
Teltartan HCT 40/12.5
Micardis Plus 40/12.5 mg
*Additional charge for this brand is $9.58
 DPMQ: $26.80 Max safety net: $18.76 General Patient Charge: $31.13