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
14421BMPNPOP	POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL (PI, CMI)	2	2	5	$18.51	$19.96	$23.41
	Available brands
	Optixa
	Systanea