SITAGLIPTIN + METFORMIN
sitagliptin 100 mg + metformin hydrochloride 1 g modified release tablet, 28
Manner of administration:Oral
Restriction (Streamlined authority code: 15276)
Indication: Diabetes mellitus type 2
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: $45.49 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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sitagliptin 50 mg + metformin hydrochloride 1 g modified release tablet, 56
Manner of administration:Oral
Restriction (Streamlined authority code: 15276)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $46.55 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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sitagliptin 50 mg + metformin hydrochloride 1 g modified release tablet, 56
Manner of administration:Oral
Restriction (Streamlined authority code: 15288)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 5 | DPMQ: $79.32 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 15288)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 5 | DPMQ: $57.52 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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sitagliptin 100 mg + metformin hydrochloride 1 g modified release tablet, 28
Manner of administration:Oral
Restriction (Streamlined authority code: 15288)
Indication: Diabetes mellitus type 2
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: $77.20 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Manner of administration:Oral
Restriction (Streamlined authority code: 15288)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 5 | DPMQ: $59.62 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 15288)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 112 | # of repeats: 5 | DPMQ: $58.98 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Manner of administration:Oral
Restriction (Streamlined authority code: 15276)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $35.65 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Manner of administration:Oral
Restriction (Streamlined authority code: 15276)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $36.38 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Manner of administration:Oral
Restriction (Streamlined authority code: 15276)
Indication: Diabetes mellitus type 2
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 56 | # of repeats: 5 | DPMQ: $36.70 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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