EZETIMIBE + SIMVASTATIN

EZETIMIBE + SIMVASTATIN (13595M)

ezetimibe 10 mg + simvastatin 80 mg tablet, 30
13595M
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: $30.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/80
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/80
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/80
Zimybe 10/80
Vytorin
*Additional charge for this brand is $6.00
 DPMQ: $36.06 Max safety net: $25.00 General Patient Charge: $31.00

EZETIMIBE + SIMVASTATIN (8882L)

ezetimibe 10 mg + simvastatin 80 mg tablet, 30
8882L
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: $21.92 Max safety net: $23.40 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/80
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/80
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/80
Zimybe 10/80
Vytorin
*Additional charge for this brand is $3.00
 DPMQ: $24.92 Max safety net: $23.40 General Patient Charge: $28.00