EZETIMIBE + SIMVASTATIN

EZETIMIBE + SIMVASTATIN (13385L)

ezetimibe 10 mg + simvastatin 10 mg tablet, 30
13385L
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: $27.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/10
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/10
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/10
Zimybe 10/10
Vytorin
*Additional charge for this brand is $3.88
 DPMQ: $31.18 Max safety net: $25.00 General Patient Charge: $28.88

EZETIMIBE + SIMVASTATIN (13442L)

ezetimibe 10 mg + simvastatin 20 mg tablet, 30
13442L
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: $27.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/20
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/20
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/20
Zimybe 10/20
Vytorin
*Additional charge for this brand is $3.88
 DPMQ: $31.82 Max safety net: $25.00 General Patient Charge: $28.88

EZETIMIBE + SIMVASTATIN (13535J)

ezetimibe 10 mg + simvastatin 40 mg tablet, 30
13535J
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: $28.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/40
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/40
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/40
Zimybe 10/40
Vytorin
*Additional charge for this brand is $5.82
 DPMQ: $34.68 Max safety net: $25.00 General Patient Charge: $30.82

EZETIMIBE + SIMVASTATIN (13595M)

ezetimibe 10 mg + simvastatin 80 mg tablet, 30
13595M
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: $30.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/80
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/80
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/80
Zimybe 10/80
Vytorin
*Additional charge for this brand is $5.82
 DPMQ: $35.96 Max safety net: $25.00 General Patient Charge: $30.82

EZETIMIBE + SIMVASTATIN (8881K)

ezetimibe 10 mg + simvastatin 40 mg tablet, 30
8881K
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: $21.61 Max safety net: $23.15 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/40
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/40
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/40
Zimybe 10/40
Vytorin
*Additional charge for this brand is $2.91
 DPMQ: $24.52 Max safety net: $23.15 General Patient Charge: $27.91

EZETIMIBE + SIMVASTATIN (8882L)

ezetimibe 10 mg + simvastatin 80 mg tablet, 30
8882L
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: $22.25 Max safety net: $23.79 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/80
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/80
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/80
Zimybe 10/80
Vytorin
*Additional charge for this brand is $2.91
 DPMQ: $25.16 Max safety net: $23.79 General Patient Charge: $27.91

EZETIMIBE + SIMVASTATIN (9483D)

ezetimibe 10 mg + simvastatin 10 mg tablet, 30
9483D
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: $20.83 Max safety net: $22.37 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/10
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/10
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/10
Zimybe 10/10
Vytorin
*Additional charge for this brand is $1.94
 DPMQ: $22.77 Max safety net: $22.37 General Patient Charge: $26.94

EZETIMIBE + SIMVASTATIN (9484E)

ezetimibe 10 mg + simvastatin 20 mg tablet, 30
9484E
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: $21.15 Max safety net: $22.69 General Patient Charge: $25.00
Available brands
APO-Ezetimibe/Simvastatin 10/20
EZETIMIBE/SIMVASTATIN SANDOZ
EZETIMIBE/SIMVASTATIN-WGR 10/20
EZETORIN
Pharmacor Ezetimibe Simvastatin 10/20
Zimybe 10/20
Vytorin
*Additional charge for this brand is $1.94
 DPMQ: $23.09 Max safety net: $22.69 General Patient Charge: $26.94