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
10185CMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio long chain fat to carbohydrate plus protein) oral liquid, 32 x 200 mL cartons (PI, CMI)	5	5	5	$940.02	$31.60	$31.60
	Available brands
	KetoCal 4:1 LQ

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
12456NMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons (PI, CMI)	6	6	5	$1360.77	$31.60	$31.60
	Available brands
	KetoVie 4:1

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
12464BMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (3:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons (PI, CMI)	6	6	5	$929.73	$31.60	$31.60
	Available brands
	KetoVie 3:1

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
12635BMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate oral semi-solid, 36 x 100 g tubs (PI, CMI)	4	4	5	$794.79	$31.60	$31.60
	Available brands
	K.Yo

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

Note

Authority Required

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
12789DMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons (PI, CMI)	6	6	5	$1540.41	$31.60	$31.60
	Available brands
	KetoVie Peptide 4:1

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
2652NMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (3:1 ratio long chain fat to carbohydrate plus protein) powder for oral liquid, 300 g (PI, CMI)	24	24	5	$985.23	$31.60	$31.60
	Available brands
	KetoCal 3:1

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
9446EMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio long chain fat to carbohydate plus protein) powder for oral liquid, 300 g (PI, CMI)	24	24	5	$985.23	$31.60	$31.60
	Available brands
	KetoCal 4:1