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 $8.00B	2	56	5	$53.15	$31.60	$39.60