Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
10258XMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid: powder for, 30 x 36 g sachets (PI, CMI)	4	4	5	$869.84	$31.60	$31.60
	Available brands
	PKU Anamix Junior

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
10411YMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 174 mL pouches (PI, CMI)	4	4	5	$1692.60	$31.60	$31.60
	Available brands
	PKU Air 20

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
12136RMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 28 g sachets (PI, CMI)	4	4	5	$1673.28	$31.60	$31.60
	Available brands
	PKU Lophlex

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
14290DMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 125 mL pouches (PI, CMI)	4	4	5	$1673.28	$31.60	$31.60
	Available brands
	PKU Lophlex Select LQ

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
1909LMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 34 g sachets (PI, CMI)	4	4	5	$1692.60	$31.60	$31.60
	Available brands
	PKU express 20

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
2382JMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 87 mL pouches (PI, CMI)	4	4	5	$849.96	$31.60	$31.60
	Available brands
	PKU Cooler 10

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
2474FMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 174 mL pouches (PI, CMI)	4	4	5	$1692.60	$31.60	$31.60
	Available brands
	PKU Cooler 20

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
2739EMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 500 g (PI, CMI)	8	8	5	$1109.84	$31.60	$31.60
	Available brands
	XP Maxamum

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
2806QMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral semi-solid, 36 x 109 g tubs (PI, CMI)	3	3	5	$1520.97	$31.60	$31.60
	Available brands
	PKU Lophlex Sensation 20

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
5483NMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 85 g sachets (PI, CMI)	4	4	5	$868.88	$31.60	$31.60
	Available brands
	PKU squeezie

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
8591EMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine powder for oral liquid, 30 x 25 g sachets (PI, CMI)	4	4	5	$1271.12	$31.60	$31.60
	Available brands
	PKU express 15

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
8746HMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 18 x 250 mL (PI, CMI)	5	90	5	$852.83	$31.60	$31.60
	Available brands
	Easiphen

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
8846NMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 130 mL pouches (PI, CMI)	4	4	5	$1270.44	$31.60	$31.60
	Available brands
	PKU Cooler 15

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
9021TMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 125 mL pouches (PI, CMI)	4	4	5	$1673.28	$31.60	$31.60
	Available brands
	PKU Lophlex LQ 20

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
9396MMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 36 x 125 mL bottles (PI, CMI)	4	4	5	$1042.08	$31.60	$31.60
	Available brands
	PKU Anamix Junior LQ

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

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
9397NMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 60 x 62.5 mL pouches (PI, CMI)	2	2	5	$681.02	$31.60	$31.60
	Available brands
	PKU Lophlex LQ 10