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
13385LMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 10 mg tablet, 30 (PI, CMI)	2	60	5	$27.14	$28.62	$31.60
	Available brands
	APO-Ezetimibe/Simvastatin 10/10a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/10a
	EZETORINa
	EzSimva GH 10/10a
	Pharmacor Ezetimibe Simvastatin 10/10a
	Vytorina
	Zimybe 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
13442LMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 20 mg tablet, 30 (PI, CMI)	2	60	5	$27.80	$29.28	$31.60
	Available brands
	APO-Ezetimibe/Simvastatin 10/20a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/20a
	EZETORINa
	EzSimva GH 10/20a
	Pharmacor Ezetimibe Simvastatin 10/20a
	Vytorina
	Zimybe 10/20a

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
13535JMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 40 mg tablet, 30 (PI, CMI)	2	60	5	$28.74	$30.22	$31.60
	Available brands
	APO-Ezetimibe/Simvastatin 10/40a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/40a
	EZETORINa
	EzSimva GH 10/40a
	Pharmacor Ezetimibe Simvastatin 10/40a
	Zimybe 10/40a
	Vytorina * Additional charge for this brand is $3.20B	2	60	5	$31.94	$30.22	$34.80

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
13595MMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 80 mg tablet, 30 (PI, CMI)	2	60	5	$30.06	$31.54	$31.60
	Available brands
	APO-Ezetimibe/Simvastatin 10/80a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/80a
	EZETORINa
	EzSimva GH 10/80a
	Pharmacor Ezetimibe Simvastatin 10/80a
	Zimybe 10/80a
	Vytorina * Additional charge for this brand is $3.18B	2	60	5	$33.24	$31.54	$34.78

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
8881KMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 40 mg tablet, 30 (PI, CMI)	1	30	5	$21.26	$22.74	$26.19
	Available brands
	APO-Ezetimibe/Simvastatin 10/40a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/40a
	EZETORINa
	EzSimva GH 10/40a
	Pharmacor Ezetimibe Simvastatin 10/40a
	Zimybe 10/40a
	Vytorina * Additional charge for this brand is $1.60B	1	30	5	$22.86	$22.74	$27.79

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
8882LMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 80 mg tablet, 30 (PI, CMI)	1	30	5	$21.92	$23.40	$26.85
	Available brands
	APO-Ezetimibe/Simvastatin 10/80a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/80a
	EZETORINa
	EzSimva GH 10/80a
	Pharmacor Ezetimibe Simvastatin 10/80a
	Zimybe 10/80a
	Vytorina * Additional charge for this brand is $1.59B	1	30	5	$23.51	$23.40	$28.44

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
9483DMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 10 mg tablet, 30 (PI, CMI)	1	30	5	$20.46	$21.94	$25.39
	Available brands
	APO-Ezetimibe/Simvastatin 10/10a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/10a
	EZETORINa
	EzSimva GH 10/10a
	Pharmacor Ezetimibe Simvastatin 10/10a
	Vytorina
	Zimybe 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
9484EMPNP	EZETIMIBE + SIMVASTATIN ezetimibe 10 mg + simvastatin 20 mg tablet, 30 (PI, CMI)	1	30	5	$20.79	$22.27	$25.72
	Available brands
	APO-Ezetimibe/Simvastatin 10/20a
	EZETIMIBE/SIMVASTATIN SANDOZa
	EZETIMIBE/SIMVASTATIN-WGR 10/20a
	EZETORINa
	EzSimva GH 10/20a
	Pharmacor Ezetimibe Simvastatin 10/20a
	Vytorina
	Zimybe 10/20a