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
8623WMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$17.76	$19.21	$22.66
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	TELMISARTAN HCTZ-WGR 80/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $10.00B	1	28	5	$27.76	$19.21	$32.66