IRBESARTAN + HYDROCHLOROTHIAZIDE

IRBESARTAN + HYDROCHLOROTHIAZIDE (13446Q)

irbesartan 300 mg + hydrochlorothiazide 25 mg tablet, 30
13446Q
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: $22.68 Max safety net: $24.22 General Patient Charge: $25.00
Available brands
APO-Irbesartan HCTZ
AVSARTAN HCT 300/25
Abisart HCTZ 300/25
IRBESARTAN HCTZ-WGR 300/25
Irbesartan/HCT Sandoz
Avapro HCT 300/25
*Additional charge for this brand is $7.68
 DPMQ: $30.36 Max safety net: $24.22 General Patient Charge: $32.68
Karvezide 300/25
*Additional charge for this brand is $7.68
 DPMQ: $30.36 Max safety net: $24.22 General Patient Charge: $32.68