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
5285EMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$25.32	$26.80	$30.25
	Available brands
	Amlodipine/Valsartan/HCT Novartis 5/160/12.5a
	Exforge HCT 5/160/12.5a * Additional charge for this brand is $12.00B	1	28	5	$37.32	$26.80	$42.25

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
5286FMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 5 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$26.83	$28.31	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 5/160/25a
	Exforge HCT 5/160/25a * Additional charge for this brand is $8.00B	1	28	5	$34.83	$28.31	$39.60

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
5287GMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 12.5 mg tablet, 28 (PI, CMI)	1	28	5	$25.84	$27.32	$30.77
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/160/12.5a
	Exforge HCT 10/160/12.5a * Additional charge for this brand is $8.00B	1	28	5	$33.84	$27.32	$38.77

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
5288HMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 160 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$27.36	$28.84	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/160/25a
	Exforge HCT 10/160/25a * Additional charge for this brand is $12.00B	1	28	5	$39.36	$28.84	$43.60

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
5289JMPNP	AMLODIPINE + VALSARTAN + HYDROCHLOROTHIAZIDE amlodipine 10 mg + valsartan 320 mg + hydrochlorothiazide 25 mg tablet, 28 (PI, CMI)	1	28	5	$29.63	$31.11	$31.60
	Available brands
	Amlodipine/Valsartan/HCT Novartis 10/320/25a
	Exforge HCT 10/320/25a * Additional charge for this brand is $8.00B	1	28	5	$37.63	$31.11	$39.60