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
13546YMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$19.13	$20.58	$24.03
	Available brands
	APO-Telmisartan HCTZ 40/12.5a
	Mizart HCT 40/12.5 mga
	TELMISARTAN HCTZ-WGR 40/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 40/12.5a
	Micardis Plus 40/12.5 mga * Additional charge for this brand is $11.08B	2	56	5	$30.21	$20.58	$35.11

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
13574KMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$22.07	$23.52	$26.97
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	TELMISARTAN HCTZ-WGR 80/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $8.02B	2	56	5	$30.09	$23.52	$34.99

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
13607EMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	2	56	5	$22.73	$24.18	$27.63
	Available brands
	APO-Telmisartan HCTZ 80/25a
	Mizart HCT 80/25 mga
	TELMISARTAN HCTZ-WGR 80/25a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/25a
	Micardis Plus 80/25 mga * Additional charge for this brand is $7.94B	2	56	5	$30.67	$24.18	$35.57

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
8622TMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$16.29	$17.74	$21.19
	Available brands
	APO-Telmisartan HCTZ 40/12.5a
	Mizart HCT 40/12.5 mga
	TELMISARTAN HCTZ-WGR 40/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 40/12.5a
	Micardis Plus 40/12.5 mga * Additional charge for this brand is $5.54B	1	28	5	$21.83	$17.74	$26.73

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
8623WMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$17.76	$19.21	$22.66
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	TELMISARTAN HCTZ-WGR 80/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $4.01B	1	28	5	$21.77	$19.21	$26.67

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
9381RMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$18.09	$19.54	$22.99
	Available brands
	APO-Telmisartan HCTZ 80/25a
	Mizart HCT 80/25 mga
	TELMISARTAN HCTZ-WGR 80/25a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/25a
	Micardis Plus 80/25 mga * Additional charge for this brand is $3.97B	1	28	5	$22.06	$19.54	$26.96