Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

Note

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
10376DMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 80 mg tablet, 30 (PI, CMI)	1	30	5	$23.41	$24.86	$28.31
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/80a
	Atozeta * Additional charge for this brand is $2.21B	1	30	5	$25.62	$24.86	$30.52

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

Note

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
10377EMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 40 mg tablet, 30 (PI, CMI)	1	30	5	$22.42	$23.87	$27.32
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/40a
	Atozeta * Additional charge for this brand is $2.22B	1	30	5	$24.64	$23.87	$29.54

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

Note

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
10392YMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 10 mg tablet, 30 (PI, CMI)	1	30	5	$20.95	$22.40	$25.85
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/10a
	Atozeta * Additional charge for this brand is $2.15B	1	30	5	$23.10	$22.40	$28.00

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

Note

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
10393BMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 20 mg tablet, 30 (PI, CMI)	1	30	5	$21.51	$22.96	$26.41
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/20a
	Atozeta * Additional charge for this brand is $2.16B	1	30	5	$23.67	$22.96	$28.57

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
13416DMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 40 mg tablet, 30 (PI, CMI)	2	60	5	$31.39	$31.60	$31.60
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/40a
	Atozeta * Additional charge for this brand is $4.44B	2	60	5	$35.83	$31.60	$36.04

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
13538MMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 80 mg tablet, 30 (PI, CMI)	2	60	5	$33.37	$31.60	$31.60
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/80a
	Atozeta * Additional charge for this brand is $4.42B	2	60	5	$37.79	$31.60	$36.02

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
13539NMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 10 mg tablet, 30 (PI, CMI)	2	60	5	$28.45	$29.90	$31.60
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/10a
	Atozeta * Additional charge for this brand is $4.30B	2	60	5	$32.75	$29.90	$35.90

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
13622YMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 20 mg tablet, 30 (PI, CMI)	2	60	5	$29.57	$31.02	$31.60
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/20a
	Atozeta * Additional charge for this brand is $4.32B	2	60	5	$33.89	$31.02	$35.92