Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10109CMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	7	$209.07	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10110DMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	7	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10118MMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	7	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10122RMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	7	$226.31	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10956PMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	6	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10967FMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	6	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10968GMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	6	$226.31	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10973MMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	6	$209.07	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11163MMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$443.74	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11168TMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$418.14	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11175EMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$443.74	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11176FMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$418.14	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11824HMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$209.07	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11825JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	0	$226.31	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11826KMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	0	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11828MMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	0	$209.07	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11835XMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11840EMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11846LMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	0	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11864KMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$226.31	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11932BMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	0	$226.31	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11945QMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$209.07	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11946RMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11950YMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	0	$209.07	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11952CMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11953DMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$226.31	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11958JMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	0	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11962NMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	0	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14882GMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14883HMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$226.31	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14884JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	7	$209.07	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14885KMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	7	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14895YMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	2	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14903JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	2	$443.74	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14904KMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	7	$117.60	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14905LMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	0	$104.54	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14906MMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	5	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14911TMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$443.74	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14912WMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	0	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14913XMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	5	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14919FMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14920GMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14921HMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14922JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$209.07	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14923KMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	7	$226.31	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14927PMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$226.31	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14928QMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$226.31	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14929RMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$209.07	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14930TMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	5	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14937EMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	5	$418.14	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14938FMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	5	$443.74	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14939GMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	0	$117.60	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14940HMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	2	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14945NMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	2	$418.14	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14946PMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$418.14	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14947QMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14948RMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$209.07	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14949TMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	7	$104.54	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14950WMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14951XMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	5	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14952YMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	0	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14953BMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	7	$443.75	$31.60	$31.60
	Available brands
	Xolair