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
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