Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

Authority Required (STREAMLINED)

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
11852TMPNP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 10 mL (PI, CMI)	1	1	5	$25.01	$26.46	$29.91
	Available brands
	Evolve Carmellose

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

Authority Required (STREAMLINED)

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
11853WOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 10 mL (PI, CMI)	1	1	5	$25.01	$26.46	$29.91
	Available brands
	Evolve Carmellose

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

Authority Required (STREAMLINED)

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
14319PMPNPOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 10 mL (PI, CMI)	2	2	5	$36.57	$31.60	$31.60
	Available brands
	Evolve Carmellose

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
14452PMPNPOP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	6	6	5	$40.83	$31.60	$31.60
	Available brands
	Celluvisc

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
14522HMPNPOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	6	6	5	$40.83	$31.60	$31.60
	Available brands
	Cellufresh

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
2324HMPNP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$27.15	$28.60	$31.60
	Available brands
	Celluvisc

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
2338CMPNP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$27.15	$28.60	$31.60
	Available brands
	Cellufresh

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
5505ROP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$27.15	$28.60	$31.60
	Available brands
	Celluvisc

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
5506TOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$27.15	$28.60	$31.60
	Available brands
	Cellufresh

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

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
5507WOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 15 mL (PI, CMI)	1	1	5	$16.61	$18.06	$21.51
	Available brands
	Refresh Tears Plus

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

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
5508XOP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 15 mL (PI, CMI)	1	1	5	$16.61	$18.06	$21.51
	Available brands
	Refresh Liquigel

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

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
8548XMPNP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 15 mL (PI, CMI)	1	1	5	$16.61	$18.06	$21.51
	Available brands
	Refresh Tears Plus

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

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
8593GMPNP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 15 mL (PI, CMI)	1	1	5	$16.61	$18.06	$21.51
	Available brands
	Refresh Liquigel

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

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
9211TMP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 15 mL (PI, CMI)	1	1	11	$16.61	$18.06	$21.51
	Available brands
	Refresh Tears Plus

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

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
9212WMP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 15 mL (PI, CMI)	1	1	11	$16.61	$18.06	$21.51
	Available brands
	Refresh Liquigel