Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

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
13817FMP	NIVOLUMAB + RELATLIMAB nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial (PI, CMI)	2	2	11	$18195.80	$31.60	$31.60
	Available brands
	Opdualag

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

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
13826QMP	NIVOLUMAB + RELATLIMAB nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial (PI, CMI)	2	2	8	$18244.17	$31.60	$31.60
	Available brands
	Opdualag

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

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
13829WMP	NIVOLUMAB + RELATLIMAB nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial (PI, CMI)	2	2	11	$18244.17	$31.60	$31.60
	Available brands
	Opdualag

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

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
13830XMP	NIVOLUMAB + RELATLIMAB nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial (PI, CMI)	2	2	8	$18195.80	$31.60	$31.60
	Available brands
	Opdualag