Document ID: chunk:federal_register_of_legislation:F2025C00217:schedule:1:p1
Version: federal_register_of_legislation:F2025C00217
Segment Type: schedule
Provision Reference: sch 1 (pt 1/13)
Character Range: 6017–17564

Schedule 1—Determined and claimed prices

Note: See sections 6 and 7.

Listed drug                                           Form                                                                                                                                                                                      Manner of administration  Brand                                                 Pricing quantity/ pack quantity  Determined price $  Claimed price $
Allopurinol                                           Tablet 100 mg                                                                                                                                                                             Oral                      Zyloprim                                              200                              4.52                9.75
                                                      Tablet 300 mg                                                                                                                                                                             Oral                      Zyloprim                                              60                               3.50                8.74
Amitriptyline                                         Tablet containing amitriptyline hydrochloride 10 mg                                                                                                                                       Oral                      Endep 10                                              50                               2.83                4.65
                                                      Tablet containing amitriptyline hydrochloride 25 mg                                                                                                                                       Oral                      Endep 25                                              50                               3.01                4.83
                                                      Tablet containing amitriptyline hydrochloride 50 mg                                                                                                                                       Oral                      Endep 50                                              50                               3.38                5.20
Amlodipine                                            Tablet 5 mg (as besilate)                                                                                                                                                                 Oral                      Norvasc                                               30                               2.50                12.91
                                                      Tablet 10 mg (as besilate)                                                                                                                                                                Oral                      Norvasc                                               30                               2.50                12.92
Amlodipine with atorvastatin                          Tablet 5 mg amlodipine (as besilate) with 40 mg atorvastatin (as calcium)                                                                                                                 Oral                      Caduet 5/40                                           30                               3.78                8.43
                                                      Tablet 5 mg amlodipine (as besilate) with 80 mg atorvastatin (as calcium)                                                                                                                 Oral                      Caduet 5/80                                           30                               5.05                9.70
                                                      Tablet 10 mg amlodipine (as besilate) with 10 mg atorvastatin (as calcium)                                                                                                                Oral                      Caduet 10/10                                          30                               3.39                8.04
                                                      Tablet 10 mg amlodipine (as besilate) with 20 mg atorvastatin (as calcium)                                                                                                                Oral                      Caduet 10/20                                          30                               3.57                8.22
                                                      Tablet 10 mg amlodipine (as besilate) with 40 mg atorvastatin (as calcium)                                                                                                                Oral                      Caduet 10/40                                          30                               4.42                9.07
                                                      Tablet 10 mg amlodipine (as besilate) with 80 mg atorvastatin (as calcium)                                                                                                                Oral                      Caduet 10/80                                          30                               5.69                10.34
Amlodipine with valsartan                             Tablet 5 mg (as besilate)‑80 mg                                                                                                                                                           Oral                      Exforge 5/80                                          28                               7.42                13.00
                                                      Tablet 5 mg (as besilate)‑160 mg                                                                                                                                                          Oral                      Exforge 5/160                                         28                               9.31                14.89
                                                      Tablet 5 mg (as besilate)‑320 mg                                                                                                                                                          Oral                      Exforge 5/320                                         28                               11.72               17.30
                                                      Tablet 10 mg (as besilate)‑160 mg                                                                                                                                                         Oral                      Exforge 10/160                                        28                               9.80                15.38
                                                      Tablet 10 mg (as besilate)‑320 mg                                                                                                                                                         Oral                      Exforge 10/320                                        28                               11.91               17.49
Amlodipine with valsartan and hydrochlorothiazide     Tablet 5 mg (as besilate)‑160 mg‑12.5 mg                                                                                                                                                  Oral                      Exforge HCT 5/160/12.5                                28                               10.72               21.88
                                                      Tablet 5 mg (as besilate)‑160 mg‑25 mg                                                                                                                                                    Oral                      Exforge HCT 5/160/25                                  28                               12.13               17.71
                                                      Tablet 10 mg (as besilate)‑160 mg‑12.5 mg                                                                                                                                                 Oral                      Exforge HCT 10/160/12.5                               28                               11.21               16.79
                                                      Tablet 10 mg (as besilate)‑160 mg‑25 mg                                                                                                                                                   Oral                      Exforge HCT 10/160/25                                 28                               12.62               23.78
                                                      Tablet 10 mg (as besilate)‑320 mg‑25 mg                                                                                                                                                   Oral                      Exforge HCT 10/320/25                                 28                               14.73               20.31
Amoxicillin                                           Capsule 250 mg (as trihydrate)                                                                                                                                                            Oral                      Amoxil                                                20                               2.50                6.87
                                                      Capsule 500 mg (as trihydrate)                                                                                                                                                            Oral                      Amoxil                                                20                               2.50                6.86
                                                      Powder for oral suspension 125 mg (as trihydrate) per 5 mL, 100 mL                                                                                                                        Oral                      Amoxil                                                1                                2.50                6.94
                                                      Powder for oral suspension 250 mg (as trihydrate) per 5 mL, 100 mL                                                                                                                        Oral                      Amoxil Forte                                          1                                2.50                6.72

                                                      Powder for paediatric oral drops 100 mg (as trihydrate) per mL, 20 mL                                                                                                                     Oral                      Amoxil                                                1                                5.88                6.37
                                                      Tablet 1 g (as trihydrate)                                                                                                                                                                Oral                      Maxamox                                               14                               2.50                3.50
Amoxicillin with clavulanic acid                      Powder for oral suspension containing 400 mg amoxicillin