VALSARTAN + HYDROCHLOROTHIAZIDE

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: $32.50 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Co-Diovan 160/25
Dilart HCT 160/25
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: $23.14 Max safety net: $24.62 General Patient Charge: $25.00
Available brands
Co-Diovan 160/25
Dilart HCT 160/25