Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
10376DMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 80 mg tablet, 30 (PI, CMI)	1	30	5	$27.71	$25.00	$25.00
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/80a
	Atozeta * Additional charge for this brand is $3.00B	1	30	5	$30.71	$25.00	$28.00

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
10377EMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 40 mg tablet, 30 (PI, CMI)	1	30	5	$24.90	$25.00	$25.00
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/40a
	Atozeta * Additional charge for this brand is $2.22B	1	30	5	$27.12	$25.00	$27.22

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
10392YMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 10 mg tablet, 30 (PI, CMI)	1	30	5	$22.36	$23.84	$25.00
	Available brands
	Atozeta
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/10a

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, COMBINATIONS

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
10393BMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 20 mg tablet, 30 (PI, CMI)	1	30	5	$22.92	$24.40	$25.00
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/20a
	Atozeta * Additional charge for this brand is $2.20B	1	30	5	$25.12	$24.40	$27.20

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, 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
13416DMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 40 mg tablet, 30 (PI, CMI)	2	60	5	$36.02	$25.00	$25.00
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/40a
	Atozeta * Additional charge for this brand is $4.44B	2	60	5	$40.46	$25.00	$29.44

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, 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
13538MMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 80 mg tablet, 30 (PI, CMI)	2	60	5	$41.64	$25.00	$25.00
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/80a
	Atozeta * Additional charge for this brand is $6.00B	2	60	5	$47.64	$25.00	$31.00

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, 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
13539NMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 10 mg tablet, 30 (PI, CMI)	2	60	5	$30.94	$25.00	$25.00
	Available brands
	Atozeta
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/10a

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > LIPID MODIFYING AGENTS > LIPID MODIFYING AGENTS, 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
13622YMPNP	EZETIMIBE + ATORVASTATIN ezetimibe 10 mg + atorvastatin 20 mg tablet, 30 (PI, CMI)	2	60	5	$32.06	$25.00	$25.00
	Available brands
	Ezetasta
	Ezetimibe/Atorvastatin GH 10/20a
	Atozeta * Additional charge for this brand is $4.40B	2	60	5	$36.46	$25.00	$29.40