Source	S100 HSD Private
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
10386PMP	POMALIDOMIDE pomalidomide 4 mg capsule, 21 (PI, CMI)	1	21	0	$2,351.02	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Public
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
10387QMP	POMALIDOMIDE pomalidomide 4 mg capsule, 21 (PI, CMI)	1	21	0	$2,302.14	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Public
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
10406QMP	POMALIDOMIDE pomalidomide 3 mg capsule, 21 (PI, CMI)	1	21	0	$1,726.61	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Private
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
10417GMP	POMALIDOMIDE pomalidomide 3 mg capsule, 21 (PI, CMI)	1	21	0	$1,775.49	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Private
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
12661JMP	POMALIDOMIDE pomalidomide 4 mg capsule, 14 (PI, CMI)	1	14	2	$1,583.64	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Public
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
12665NMP	POMALIDOMIDE pomalidomide 4 mg capsule, 14 (PI, CMI)	1	14	2	$1,534.76	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Public
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
12666PMP	POMALIDOMIDE pomalidomide 3 mg capsule, 14 (PI, CMI)	1	14	2	$1,151.07	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Private
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
12668RMP	POMALIDOMIDE pomalidomide 3 mg capsule, 14 (PI, CMI)	1	14	2	$1,199.95	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomalyst
	Pomolide

Source	S100 HSD Public
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
13788QMP	POMALIDOMIDE pomalidomide 2 mg capsule, 21 (PI, CMI)	1	21	0	$1,151.07	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomolide

Source	S100 HSD Public
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
13794BMP	POMALIDOMIDE pomalidomide 1 mg capsule, 14 (PI, CMI)	1	14	2	$430.49	$25.00	$25.00
	Available brands
	Pomolide

Source	S100 HSD Public
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
13803LMP	POMALIDOMIDE pomalidomide 1 mg capsule, 21 (PI, CMI)	1	21	0	$645.74	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomolide

Source	S100 HSD Private
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
13811XMP	POMALIDOMIDE pomalidomide 2 mg capsule, 21 (PI, CMI)	1	21	0	$1,199.95	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomolide

Source	S100 HSD Private
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
13812YMP	POMALIDOMIDE pomalidomide 2 mg capsule, 14 (PI, CMI)	1	14	2	$806.96	$25.00	$25.00
	Available brands
	Pomolide

Source	S100 HSD Private
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
13813BMP	POMALIDOMIDE pomalidomide 1 mg capsule, 14 (PI, CMI)	1	14	2	$456.59	$25.00	$25.00
	Available brands
	Pomolide

Source	S100 HSD Private
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
13814CMP	POMALIDOMIDE pomalidomide 1 mg capsule, 21 (PI, CMI)	1	21	0	$680.45	$25.00	$25.00
	Available brands
	Pomalidomide Sandoz
	Pomolide

Source	S100 HSD Public
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
13815DMP	POMALIDOMIDE pomalidomide 2 mg capsule, 14 (PI, CMI)	1	14	2	$767.38	$25.00	$25.00
	Available brands
	Pomolide