TELMISARTAN + HYDROCHLOROTHIAZIDE

TELMISARTAN + HYDROCHLOROTHIAZIDE (13607E)

telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28
13607E
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: $23.46 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Telmisartan HCTZ 80/25
Mizart HCT 80/25 mg
TELMISARTAN HCTZ-WGR 80/25
Telmisartan/HCT Sandoz
Teltartan HCT 80/25
Micardis Plus 80/25 mg
*Additional charge for this brand is $19.30
 DPMQ: $42.76 Max safety net: $25.00 General Patient Charge: $44.30

TELMISARTAN + HYDROCHLOROTHIAZIDE (9381R)

telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28
9381R
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: $18.91 Max safety net: $20.45 General Patient Charge: $23.24
Available brands
APO-Telmisartan HCTZ 80/25
Mizart HCT 80/25 mg
TELMISARTAN HCTZ-WGR 80/25
Telmisartan/HCT Sandoz
Teltartan HCT 80/25
Micardis Plus 80/25 mg
*Additional charge for this brand is $9.65
 DPMQ: $28.56 Max safety net: $20.45 General Patient Charge: $32.89