TRANDOLAPRIL

TRANDOLAPRIL (13467T)

trandolapril 4 mg capsule, 28
13467T
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: $31.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dolapril 4
Tranalpha
Trandolapril Viatris
Gopten
*Additional charge for this brand is $6.78
 DPMQ: $38.58 Max safety net: $25.00 General Patient Charge: $31.78

TRANDOLAPRIL (8758Y)

trandolapril 4 mg capsule, 28
8758Y
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: $23.08 Max safety net: $24.62 General Patient Charge: $25.00
Available brands
Dolapril 4
Tranalpha
Trandolapril Viatris
Gopten
*Additional charge for this brand is $3.39
 DPMQ: $26.47 Max safety net: $24.62 General Patient Charge: $28.39