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

Note

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
10056GMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$203.73	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10058JMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$203.73	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10060LMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$429.98	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10064QMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10068XMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.56	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10071CMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$220.25	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10072DMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10073EMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.56	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10077JMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10078KMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$429.98	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10079LMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$220.25	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
10081NMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$31.60	$31.60
	Available brands
	Actemra

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
10951JMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	3	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
10954MMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11565QMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	3	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11567TMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
11720WMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	2	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11721XMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	6	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11722YMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	6	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11725DMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	3	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11730JMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11734NMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	1	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11741YMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	3	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
11742BMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	2	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11743CMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11744DMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11748HMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	1	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

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
11750KMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
12083YMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	3	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12084BMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
12085CMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	1	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12086DMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	2	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12090HMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	2	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
12094MMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL pen devices (PI, CMI)	1	4	0	$812.80	$31.60	$31.60
	Available brands
	Actemra ACTPen

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
12095NMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	3	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12099TMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	5	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
12102YMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	0	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
12105DMP	TOCILIZUMAB tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes (PI, CMI)	1	4	1	$812.80	$31.60	$31.60
	Available brands
	Actemra Subcutaneous Injection

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

Note

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
1419QMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.56	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
1423XMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$220.25	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
1464CMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$429.98	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
1476QMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
1481YMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$203.73	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
1482BMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
9657GMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
9658HMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$203.73	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
9659JMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
9671BMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.56	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
9672CMP	TOCILIZUMAB tocilizumab 200 mg/10 mL injection, 10 mL vial (PI, CMI)	1	1	0	$220.25	$31.60	$31.60
	Available brands
	Actemra

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

Note

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
9673DMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$429.98	$31.60	$31.60
	Available brands
	Actemra