Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

Authority Required

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
4579BMP	ALPROSTADILR alprostadil 10 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes (PI, CMI)
	Available brands
	Caverject Impulse	3	6	3	$107.55	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

Authority Required

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
4580CMP	ALPROSTADILR alprostadil 20 microgram injection [1 chamber] (&) inert substance diluent [0.5 mL chamber], 2 dual chamber syringes (PI, CMI)
	Available brands
	Caverject Impulse	3	6	3	$135.87	$7.70	$7.70