Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > ANTIMETABOLITES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11271FMP	PRALATREXATE Injection (PI, CMI) Available brands Folotyn (pralatrexate 20 mg/mL injection, 1 mL vial)	80 mg	5	$4331.91	$31.60	$31.60

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > ANTIMETABOLITES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11272GMP	PRALATREXATE Injection (PI, CMI) Available brands Folotyn (pralatrexate 20 mg/mL injection, 1 mL vial)	80 mg	11	$4230.62	$31.60	$31.60

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > ANTIMETABOLITES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11278NMP	PRALATREXATE Injection (PI, CMI) Available brands Folotyn (pralatrexate 20 mg/mL injection, 1 mL vial)	80 mg	11	$4331.91	$31.60	$31.60

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > ANTIMETABOLITES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11293JMP	PRALATREXATE Injection (PI, CMI) Available brands Folotyn (pralatrexate 20 mg/mL injection, 1 mL vial)	80 mg	5	$4230.62	$31.60	$31.60