AMLODIPINE + ATORVASTATIN

AMLODIPINE + ATORVASTATIN (13415C)

amlodipine 5 mg + atorvastatin 40 mg tablet, 30
13415C
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: $21.92 Max safety net: $23.40 General Patient Charge: $25.00
Available brands
Cadivast 5/40
Caduet 5/40
*Additional charge for this brand is $10.00
 DPMQ: $31.92 Max safety net: $23.40 General Patient Charge: $35.00

AMLODIPINE + ATORVASTATIN (9051J)

amlodipine 5 mg + atorvastatin 40 mg tablet, 30
9051J
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: $17.85 Max safety net: $19.33 General Patient Charge: $22.12
Available brands
Cadivast 5/40
Caduet 5/40
*Additional charge for this brand is $5.00
 DPMQ: $22.85 Max safety net: $19.33 General Patient Charge: $27.12