PRAVASTATIN

PRAVASTATIN (13527Y)

pravastatin sodium 80 mg tablet, 30
13527Y
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: 60 # of repeats: 5 DPMQ: $25.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APX-Pravastatin
Lipostat 80
Pravachol
*Additional charge for this brand is $9.98
 DPMQ: $35.68 Max safety net: $25.00 General Patient Charge: $34.98

PRAVASTATIN (8829Q)

pravastatin sodium 80 mg tablet, 30
8829Q
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: 30 # of repeats: 5 DPMQ: $20.03 Max safety net: $21.57 General Patient Charge: $24.36
Available brands
APX-Pravastatin
Lipostat 80
Pravachol
*Additional charge for this brand is $4.99
 DPMQ: $25.02 Max safety net: $21.57 General Patient Charge: $29.35