Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

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
10152HMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula powder for oral liquid, 400 g (PI, CMI)	8	8	5	$404.35	$31.60	$31.60
	Available brands
	Monogen

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

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
10154KMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula powder for oral liquid, 400 g (PI, CMI)	8	8	5	$265.23	$31.60	$31.60
	Available brands
	Peptamen Junior

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

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
10155LMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula powder for oral liquid, 400 g (PI, CMI)	8	8	5	$365.31	$31.60	$31.60
	Available brands
	Lipistart

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

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
12948LMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula oral liquid, 12 x 500 mL bottles (PI, CMI)	12	12	5	$1553.07	$31.60	$31.60
	Available brands
	Nutrini Peptisorb

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

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
1938BMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula powder for oral liquid, 400 g (PI, CMI)	8	8	5	$365.31	$31.60	$31.60
	Available brands
	Lipistart

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Note

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
8478FMPNP	TRIGLYCERIDES MEDIUM CHAIN FORMULA triglycerides medium chain formula powder for oral liquid, 400 g (PI, CMI)	8	8	5	$404.35	$31.60	$31.60
	Available brands
	Monogen