Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10005NMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	1	30	5	$19.45	$20.90	$24.35
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 20/5/12.5a
	Olamlo HCT 20/5/12.5a
	Olmekar HCT 20/5/12.5a
	Sevikar HCT 20/5/12.5a * Additional charge for this brand is $3.00B	1	30	5	$22.45	$20.90	$27.35

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13481MMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	2	60	5	$25.45	$26.90	$30.35
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 20/5/12.5a
	Olamlo HCT 20/5/12.5a
	Olmekar HCT 20/5/12.5a
	Sevikar HCT 20/5/12.5a * Additional charge for this brand is $6.00B	2	60	5	$31.45	$26.90	$36.35

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13482NMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	2	60	5	$31.95	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/12.5a
	Olamlo HCT 40/10/12.5a
	Olmekar HCT 40/10/12.5a
	Sevikar HCT 40/10/12.5a * Additional charge for this brand is $8.52B	2	60	5	$40.47	$31.60	$40.12

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13512EMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	2	60	5	$34.25	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/25 tableta
	Olamlo HCT 40/5/25a
	Olmekar HCT 40/5/25a
	Sevikar HCT 40/5/25a * Additional charge for this brand is $5.34B	2	60	5	$39.59	$31.60	$36.94

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13513FMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	2	60	5	$31.13	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/12.5 tableta
	Olamlo HCT 40/5/12.5a
	Olmekar HCT 40/5/12.5a
	Sevikar HCT 40/5/12.5a * Additional charge for this brand is $5.24B	2	60	5	$36.37	$31.60	$36.84

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
14002YMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	2	60	5	$35.01	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/25a
	Olamlo HCT 40/10/25a
	Olmekar HCT 40/10/25a
	Sevikar HCT 40/10/25a * Additional charge for this brand is $5.34B	2	60	5	$40.35	$31.60	$36.94

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2836GMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	1	30	5	$22.70	$24.15	$27.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/12.5a
	Olamlo HCT 40/10/12.5a
	Olmekar HCT 40/10/12.5a
	Sevikar HCT 40/10/12.5a * Additional charge for this brand is $4.26B	1	30	5	$26.96	$24.15	$31.86

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2864RMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	1	30	5	$23.85	$25.30	$28.75
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/25 tableta
	Olamlo HCT 40/5/25a
	Olmekar HCT 40/5/25a
	Sevikar HCT 40/5/25a * Additional charge for this brand is $2.67B	1	30	5	$26.52	$25.30	$31.42

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2880NMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	1	30	5	$22.29	$23.74	$27.19
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/12.5 tableta
	Olamlo HCT 40/5/12.5a
	Olmekar HCT 40/5/12.5a
	Sevikar HCT 40/5/12.5a * Additional charge for this brand is $2.62B	1	30	5	$24.91	$23.74	$29.81

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), COMBINATIONS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2953KMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	1	30	5	$24.23	$25.68	$29.13
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/25a
	Olamlo HCT 40/10/25a
	Olmekar HCT 40/10/25a
	Sevikar HCT 40/10/25a * Additional charge for this brand is $2.67B	1	30	5	$26.90	$25.68	$31.80