Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13546YMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$19.46	$20.94	$24.39
	Available brands
	APO-Telmisartan HCTZ 40/12.5a
	Mizart HCT 40/12.5 mga
	TELMISARTAN HCTZ-WGR 40/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 40/12.5a
	Micardis Plus 40/12.5 mga * Additional charge for this brand is $20.00B	2	56	5	$39.46	$20.94	$44.39

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13574KMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	2	56	5	$22.40	$23.88	$27.33
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	TELMISARTAN HCTZ-WGR 80/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $20.00B	2	56	5	$42.40	$23.88	$47.33

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
13607EMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	2	56	5	$23.06	$24.54	$27.99
	Available brands
	APO-Telmisartan HCTZ 80/25a
	Mizart HCT 80/25 mga
	TELMISARTAN HCTZ-WGR 80/25a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/25a
	Micardis Plus 80/25 mga * Additional charge for this brand is $20.00B	2	56	5	$43.06	$24.54	$47.99

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
8622TMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 40 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$16.62	$18.10	$21.55
	Available brands
	APO-Telmisartan HCTZ 40/12.5a
	Mizart HCT 40/12.5 mga
	TELMISARTAN HCTZ-WGR 40/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 40/12.5a
	Micardis Plus 40/12.5 mga * Additional charge for this brand is $10.00B	1	28	5	$26.62	$18.10	$31.55

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
8623WMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$18.09	$19.57	$23.02
	Available brands
	APO-Telmisartan HCTZ 80/12.5a
	Mizart HCT 80/12.5 mga
	TELMISARTAN HCTZ-WGR 80/12.5a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/12.5a
	Micardis Plus 80/12.5 mga * Additional charge for this brand is $10.00B	1	28	5	$28.09	$19.57	$33.02

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM > ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs), 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
9381RMPNP	TELMISARTAN + HYDROCHLOROTHIAZIDE telmisartan 80 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$18.42	$19.90	$23.35
	Available brands
	APO-Telmisartan HCTZ 80/25a
	Mizart HCT 80/25 mga
	TELMISARTAN HCTZ-WGR 80/25a
	Telmisartan/HCT Sandoza
	Teltartan HCT 80/25a
	Micardis Plus 80/25 mga * Additional charge for this brand is $10.00B	1	28	5	$28.42	$19.90	$33.35