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
5524ROP	POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL (PI, CMI)	1	1	5	$15.98	$17.43	$20.88
	Available brands
	Optixa
	Systanea