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

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
13440JMPNP	EZETIMIBE ezetimibe 10 mg tablet, 30 (PI, CMI)	2	60	5	$23.16	$24.64	$28.09
	Available brands
	APO-Ezetimibea
	ARX-EZETIMIBEa
	BTC Ezetimibea
	EZEMICHOLa
	EZETIMIBE-WGRa
	Ezetimibe GHa
	Ezetimibe Sandoza
	Pharmacor Ezetimibe 10a
	Zient 10mga
	Ezetrola * Additional charge for this brand is $3.56B	2	60	5	$26.72	$24.64	$31.65

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

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
8757XMPNP	EZETIMIBE ezetimibe 10 mg tablet, 30 (PI, CMI)	1	30	5	$18.47	$19.95	$23.40
	Available brands
	APO-Ezetimibea
	ARX-EZETIMIBEa
	BTC Ezetimibea
	EZEMICHOLa
	EZETIMIBE-WGRa
	Ezetimibe GHa
	Ezetimibe Sandoza
	Pharmacor Ezetimibe 10a
	Zient 10mga
	Ezetrola * Additional charge for this brand is $1.78B	1	30	5	$20.25	$19.95	$25.18