AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13390RMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)
2 56 5 $40.61 $31.60 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 10/160/25a
Exforge HCT 10/160/25a
* Additional charge for this brand is $20.00B
2 56 5 $60.61 $31.60 $51.60
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13448TMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)
2 56 5 $36.53 $31.60 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 5/160/12.5a
Exforge HCT 5/160/12.5a
* Additional charge for this brand is $20.00B
2 56 5 $56.53 $31.60 $51.60
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13514GMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)
2 56 5 $37.57 $31.60 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 10/160/12.5a
Exforge HCT 10/160/12.5a
* Additional charge for this brand is $8.00B
2 56 5 $45.57 $31.60 $39.60
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13573JMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 10 mg + valsartan 320 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)
2 56 5 $45.15 $31.60 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 10/320/25a
Exforge HCT 10/320/25a
* Additional charge for this brand is $8.00B
2 56 5 $53.15 $31.60 $39.60
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13603YMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)
2 56 5 $39.55 $31.60 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 5/160/25a
Exforge HCT 5/160/25a
* Additional charge for this brand is $8.00B
2 56 5 $47.55 $31.60 $39.60
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
5285EMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)
1 28 5 $24.99 $26.44 $29.89
Available brands
Amlodipine/Valsartan/HCT Novartis 5/160/12.5a
Exforge HCT 5/160/12.5a
* Additional charge for this brand is $10.00B
1 28 5 $34.99 $26.44 $39.89
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
5286FMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)
1 28 5 $26.50 $27.95 $31.40
Available brands
Amlodipine/Valsartan/HCT Novartis 5/160/25a
Exforge HCT 5/160/25a
* Additional charge for this brand is $4.00B
1 28 5 $30.50 $27.95 $35.40
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
5287GMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)
1 28 5 $25.51 $26.96 $30.41
Available brands
Amlodipine/Valsartan/HCT Novartis 10/160/12.5a
Exforge HCT 10/160/12.5a
* Additional charge for this brand is $4.00B
1 28 5 $29.51 $26.96 $34.41
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
5288HMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)
1 28 5 $27.03 $28.48 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 10/160/25a
Exforge HCT 10/160/25a
* Additional charge for this brand is $10.00B
1 28 5 $37.03 $28.48 $41.60
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AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE

Source General Schedule
Body System CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
5289JMPNP AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE
amlodipine 10 mg + valsartan 320 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)
1 28 5 $29.30 $30.75 $31.60
Available brands
Amlodipine/Valsartan/HCT Novartis 10/320/25a
Exforge HCT 10/320/25a
* Additional charge for this brand is $4.00B
1 28 5 $33.30 $30.75 $35.60
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  • Legend
  • BBrand premium applies
  • aBrand equivalent a
  • MPMedical Practitioner
  • NPNurse Practitioner