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
13546YMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$18.65	$20.05	$23.50
	Available brands
	APO-Telmisartan HCTZ 40/12.5a
	Mizart HCT 40/12.5 mga
	Telmisartan/HCT Sandoza
	Teltartan HCT 40/12.5a
	Micardis Plus 40/12.5 mga * Additional charge for this brand is $11.08B	2	56	5	$29.73	$20.05	$34.58

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
13574KMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$21.59	$22.99	$26.44
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $8.02B	2	56	5	$29.61	$22.99	$34.46

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
13607EMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	2	56	5	$22.25	$23.65	$27.10
	Available brands
	APO-Telmisartan HCTZ 80/25a
	Mizart HCT 80/25 mga
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/25a
	Micardis Plus 80/25 mga * Additional charge for this brand is $7.94B	2	56	5	$30.19	$23.65	$35.04

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
8622TMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$15.82	$17.22	$20.67
	Available brands
	APO-Telmisartan HCTZ 40/12.5a
	Mizart HCT 40/12.5 mga
	Telmisartan/HCT Sandoza
	Teltartan HCT 40/12.5a
	Micardis Plus 40/12.5 mga * Additional charge for this brand is $5.54B	1	28	5	$21.36	$17.22	$26.21

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	$17.29	$18.69	$22.14
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $4.01B	1	28	5	$21.30	$18.69	$26.15

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
9381RMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$17.62	$19.02	$22.47
	Available brands
	APO-Telmisartan HCTZ 80/25a
	Mizart HCT 80/25 mga
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/25a
	Micardis Plus 80/25 mga * Additional charge for this brand is $3.97B	1	28	5	$21.59	$19.02	$26.44