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
13390RMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	2	56	5	$40.61	$31.60	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/160/25a
	Exforge HCT 10/160/25a * Additional charge for this brand is $24.00B	2	56	5	$64.61	$31.60	$55.60

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
13448TMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$36.53	$31.60	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 5/160/12.5a
	Exforge HCT 5/160/12.5a * Additional charge for this brand is $24.00B	2	56	5	$60.53	$31.60	$55.60

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
13514GMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$37.57	$31.60	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/160/12.5a
	Exforge HCT 10/160/12.5a * Additional charge for this brand is $12.00B	2	56	5	$49.57	$31.60	$43.60

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
13573JMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 320 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	2	56	5	$45.15	$31.60	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/320/25a
	Exforge HCT 10/320/25a * Additional charge for this brand is $12.00B	2	56	5	$57.15	$31.60	$43.60

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
13603YMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	2	56	5	$39.55	$31.60	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 5/160/25a
	Exforge HCT 5/160/25a * Additional charge for this brand is $12.00B	2	56	5	$51.55	$31.60	$43.60

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
5285EMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$24.99	$26.44	$29.89
	Available brands
	Amlodipine/Valsartan/HCT Novartis 5/160/12.5a
	Exforge HCT 5/160/12.5a * Additional charge for this brand is $12.00B	1	28	5	$36.99	$26.44	$41.89

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
5286FMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$26.50	$27.95	$31.40
	Available brands
	Amlodipine/Valsartan/HCT Novartis 5/160/25a
	Exforge HCT 5/160/25a * Additional charge for this brand is $6.00B	1	28	5	$32.50	$27.95	$37.40

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
5287GMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$25.51	$26.96	$30.41
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/160/12.5a
	Exforge HCT 10/160/12.5a * Additional charge for this brand is $6.00B	1	28	5	$31.51	$26.96	$36.41

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
5288HMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$27.03	$28.48	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/160/25a
	Exforge HCT 10/160/25a * Additional charge for this brand is $12.00B	1	28	5	$39.03	$28.48	$43.60

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
5289JMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 320 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$29.30	$30.75	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/320/25a
	Exforge HCT 10/320/25a * Additional charge for this brand is $6.00B	1	28	5	$35.30	$30.75	$37.60