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	$1,461.03	$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
10387QMP	POMALIDOMIDE pomalidomide 4 mg capsule, 21 (PI, CMI)	1	21	0	$1,412.15	$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
10406QMP	POMALIDOMIDE pomalidomide 3 mg capsule, 21 (PI, CMI)	1	21	0	$1,059.12	$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
10417GMP	POMALIDOMIDE pomalidomide 3 mg capsule, 21 (PI, CMI)	1	21	0	$1,108.00	$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
12661JMP	POMALIDOMIDE pomalidomide 4 mg capsule, 14 (PI, CMI)	1	14	2	$987.97	$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
12665NMP	POMALIDOMIDE pomalidomide 4 mg capsule, 14 (PI, CMI)	1	14	2	$941.43	$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
12666PMP	POMALIDOMIDE pomalidomide 3 mg capsule, 14 (PI, CMI)	1	14	2	$706.08	$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
12668RMP	POMALIDOMIDE pomalidomide 3 mg capsule, 14 (PI, CMI)	1	14	2	$743.20	$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
13788QMP	POMALIDOMIDE pomalidomide 2 mg capsule, 21 (PI, CMI)	1	21	0	$706.08	$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	$264.06	$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	$396.09	$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	$743.20	$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	$498.43	$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	$283.50	$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	$420.81	$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	$470.72	$25.00	$25.00
	Available brands
	Pomolide