AMLODIPINE + VALSARTAN

AMLODIPINE + VALSARTAN (13389Q)

amlodipine 10 mg + valsartan 320 mg tablet, 28
13389Q
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: $39.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 10/320
Exforge 10/320
*Additional charge for this brand is $15.52
 DPMQ: $54.72 Max safety net: $25.00 General Patient Charge: $40.52

AMLODIPINE + VALSARTAN (13421J)

amlodipine 5 mg + valsartan 80 mg tablet, 28
13421J
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: $29.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 5/80
Exforge 5/80
*Additional charge for this brand is $15.52
 DPMQ: $45.36 Max safety net: $25.00 General Patient Charge: $40.52

AMLODIPINE + VALSARTAN (13454D)

amlodipine 10 mg + valsartan 160 mg tablet, 28
13454D
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: $34.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 10/160
Exforge 10/160
*Additional charge for this brand is $15.52
 DPMQ: $50.32 Max safety net: $25.00 General Patient Charge: $40.52

AMLODIPINE + VALSARTAN (13516J)

amlodipine 5 mg + valsartan 160 mg tablet, 28
13516J
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: $33.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 5/160
Exforge 5/160
*Additional charge for this brand is $15.52
 DPMQ: $49.30 Max safety net: $25.00 General Patient Charge: $40.52

AMLODIPINE + VALSARTAN (13604B)

amlodipine 5 mg + valsartan 320 mg tablet, 28
13604B
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: $38.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 5/320
Exforge 5/320
*Additional charge for this brand is $15.52
 DPMQ: $54.32 Max safety net: $25.00 General Patient Charge: $40.52

AMLODIPINE + VALSARTAN (5459H)

amlodipine 5 mg + valsartan 320 mg tablet, 28
5459H
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: $26.58 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 5/320
Exforge 5/320
*Additional charge for this brand is $7.76
 DPMQ: $34.34 Max safety net: $25.00 General Patient Charge: $32.76

AMLODIPINE + VALSARTAN (5460J)

amlodipine 10 mg + valsartan 320 mg tablet, 28
5460J
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: $26.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 10/320
Exforge 10/320
*Additional charge for this brand is $7.76
 DPMQ: $34.54 Max safety net: $25.00 General Patient Charge: $32.76

AMLODIPINE + VALSARTAN (9375K)

amlodipine 5 mg + valsartan 80 mg tablet, 28
9375K
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: $22.10 Max safety net: $23.64 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 5/80
Exforge 5/80
*Additional charge for this brand is $7.76
 DPMQ: $29.86 Max safety net: $23.64 General Patient Charge: $32.76

AMLODIPINE + VALSARTAN (9376L)

amlodipine 5 mg + valsartan 160 mg tablet, 28
9376L
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: $24.07 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 5/160
Exforge 5/160
*Additional charge for this brand is $7.76
 DPMQ: $31.83 Max safety net: $25.00 General Patient Charge: $32.76

AMLODIPINE + VALSARTAN (9377M)

amlodipine 10 mg + valsartan 160 mg tablet, 28
9377M
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: $24.58 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amlodipine/Valsartan Novartis 10/160
Exforge 10/160
*Additional charge for this brand is $7.76
 DPMQ: $32.34 Max safety net: $25.00 General Patient Charge: $32.76