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
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