Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

Authority Required (STREAMLINED)

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
11852TMPNP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 10 mL (PI, CMI)	1	1	5	$24.54	$25.94	$29.39
	Available brands
	Evolve Carmellose

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

Authority Required (STREAMLINED)

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
11853WOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 10 mL (PI, CMI)	1	1	5	$24.54	$25.94	$29.39
	Available brands
	Evolve Carmellose

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
2324HMPNP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$26.67	$28.07	$31.52
	Available brands
	Celluvisc

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
2338CMPNP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$26.67	$28.07	$31.52
	Available brands
	Cellufresh

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
5505ROP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$26.67	$28.07	$31.52
	Available brands
	Celluvisc

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Authority Required (STREAMLINED)

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
5506TOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 30 x 0.4 mL ampoules (PI, CMI)	3	3	5	$26.67	$28.07	$31.52
	Available brands
	Cellufresh

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
5507WOP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 15 mL (PI, CMI)	1	1	5	$16.14	$17.54	$20.99
	Available brands
	Refresh Tears Plus

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
5508XOP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 15 mL (PI, CMI)	1	1	5	$16.14	$17.54	$20.99
	Available brands
	Refresh Liquigel

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
8548XMPNP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 15 mL (PI, CMI)	1	1	5	$16.14	$17.54	$20.99
	Available brands
	Refresh Tears Plus

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
8593GMPNP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 15 mL (PI, CMI)	1	1	5	$16.14	$17.54	$20.99
	Available brands
	Refresh Liquigel

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

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
9211TMP	CARMELLOSE SODIUM carmellose sodium 0.5% eye drops, 15 mL (PI, CMI)	1	1	11	$16.14	$17.54	$20.99
	Available brands
	Refresh Tears Plus

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS

Note

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
9212WMP	CARMELLOSE SODIUM carmellose sodium 1% eye drops, 15 mL (PI, CMI)	1	1	11	$16.14	$17.54	$20.99
	Available brands
	Refresh Liquigel