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
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 $12.00B	2	56	5	$51.55	$31.60	$43.60