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
10005NMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	1	30	5	$19.78	$21.26	$24.71
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 20/5/12.5a
	Olamlo HCT 20/5/12.5a
	Olmekar HCT 20/5/12.5a
	Sevikar HCT 20/5/12.5a * Additional charge for this brand is $4.00B	1	30	5	$23.78	$21.26	$28.71

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
13481MMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	2	60	5	$25.78	$27.26	$30.71
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 20/5/12.5a
	Olamlo HCT 20/5/12.5a
	Olmekar HCT 20/5/12.5a
	Sevikar HCT 20/5/12.5a * Additional charge for this brand is $8.00B	2	60	5	$33.78	$27.26	$38.71

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
13482NMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	2	60	5	$32.28	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/12.5a
	Olamlo HCT 40/10/12.5a
	Olmekar HCT 40/10/12.5a
	Sevikar HCT 40/10/12.5a * Additional charge for this brand is $8.52B	2	60	5	$40.80	$31.60	$40.12

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
13512EMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	2	60	5	$34.58	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/25 tableta
	Olamlo HCT 40/5/25a
	Olmekar HCT 40/5/25a
	Sevikar HCT 40/5/25a * Additional charge for this brand is $8.00B	2	60	5	$42.58	$31.60	$39.60

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
13513FMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	2	60	5	$31.46	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/12.5 tableta
	Olamlo HCT 40/5/12.5a
	Olmekar HCT 40/5/12.5a
	Sevikar HCT 40/5/12.5a * Additional charge for this brand is $8.00B	2	60	5	$39.46	$31.60	$39.60

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
14002YMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	2	60	5	$35.34	$31.60	$31.60
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/25a
	Olamlo HCT 40/10/25a
	Olmekar HCT 40/10/25a
	Sevikar HCT 40/10/25a * Additional charge for this brand is $8.00B	2	60	5	$43.34	$31.60	$39.60

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
2836GMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	1	30	5	$23.03	$24.51	$27.96
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/12.5a
	Olamlo HCT 40/10/12.5a
	Olmekar HCT 40/10/12.5a
	Sevikar HCT 40/10/12.5a * Additional charge for this brand is $4.26B	1	30	5	$27.29	$24.51	$32.22

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
2864RMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	1	30	5	$24.18	$25.66	$29.11
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/25 tableta
	Olamlo HCT 40/5/25a
	Olmekar HCT 40/5/25a
	Sevikar HCT 40/5/25a * Additional charge for this brand is $4.00B	1	30	5	$28.18	$25.66	$33.11

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
2880NMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 (PI, CMI)	1	30	5	$22.62	$24.10	$27.55
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/5/12.5 tableta
	Olamlo HCT 40/5/12.5a
	Olmekar HCT 40/5/12.5a
	Sevikar HCT 40/5/12.5a * Additional charge for this brand is $4.00B	1	30	5	$26.62	$24.10	$31.55

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
2953KMPNP	OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDE olmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 (PI, CMI)	1	30	5	$24.56	$26.04	$29.49
	Available brands
	APO-Olmesartan/Amlodipine/HCTZ 40/10/25a
	Olamlo HCT 40/10/25a
	Olmekar HCT 40/10/25a
	Sevikar HCT 40/10/25a * Additional charge for this brand is $4.00B	1	30	5	$28.56	$26.04	$33.49