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
10399HMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	0	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10400JMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	0	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10412BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10413CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10419JMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10420KMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10944BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10955NMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10960WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
10961XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12325QMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12326RMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12327TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12328WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12329XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12330YMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	2	4	5	$1354.03	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12331BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12332CMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	3	$711.23	$31.60	$31.60
	Available brands
	Amgevitaa

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
12333DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12334EMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12335FMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	0	$534.56	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12337HMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	5	$706.70	$31.60	$31.60
	Available brands
	Humiraa

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
12338JMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	2	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12339KMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12340LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	2	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12341MMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12342NMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	4	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12345RMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	2	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12347WMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	3	6	0	$1658.58	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

Source	S100 HSD Public
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
12348XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$622.92	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

Source	S100 HSD Private
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
12349YMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$656.21	$31.60	$31.60
	Available brands
	Amgevitaa

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
12350BMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	3	$711.23	$31.60	$31.60
	Available brands
	Amgevitaa

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
12351CMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$711.23	$31.60	$31.60
	Available brands
	Amgevita

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
12352DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12353EMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12354FMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$711.23	$31.60	$31.60
	Available brands
	Amgevitaa

Source	S100 HSD Public
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
12355GMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$622.92	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12356HMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12357JMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$711.23	$31.60	$31.60
	Available brands
	Amgevitaa

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
12358KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12359LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	2	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12360MMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12361NMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12362PMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	3	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12363QMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12364RMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	3	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12365TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12366WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12367XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

Source	S100 HSD Private
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
12368YMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$656.21	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12369BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	2	4	5	$1354.03	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12370CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12371DMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	3	$706.70	$31.60	$31.60
	Available brands
	Humiraa

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
12372EMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12373FMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	2	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12374GMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12375HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12376JMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	3	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12377KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12378LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	3	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12379MMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	0	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12380NMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	3	6	0	$2014.38	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12381PMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	3	6	0	$1658.58	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12382QMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	3	6	0	$2014.38	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12383RMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	2	4	2	$1108.39	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

Source	S100 HSD Private
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
12384TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$656.21	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12385WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	2	4	2	$1354.03	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12386XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12387YMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12388BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12389CMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12390DMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12391EMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12393GMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12394HMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	1	1	0	$676.79	$31.60	$31.60
	Available brands
	Humira

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
12395JMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	2	2	2	$1345.59	$31.60	$31.60
	Available brands
	Humira

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
12396KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	0	$652.03	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12397LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	2	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12398MMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12399NMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12400PMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	3	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12401QMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12402RMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12403TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12405XMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12406YMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	0	$618.90	$31.60	$31.60
	Available brands
	Humiraa

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
12407BMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	3	$706.70	$31.60	$31.60
	Available brands
	Humiraa

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
12408CMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	2	2	5	$1345.59	$31.60	$31.60
	Available brands
	Humira

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
12409DMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12410EMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12411FMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	0	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12412GMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	2	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12413HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12414JMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	2	4	5	$1108.39	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12415KMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12416LMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	3	6	0	$2027.04	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

Source	S100 HSD Public
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
12417MMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$622.92	$31.60	$31.60
	Available brands
	Amgevitaa

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
12419PMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12420QMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12421RMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	4	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12422TMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12423WMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	0	$706.70	$31.60	$31.60
	Available brands
	Humiraa

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
12424XMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	5	$706.70	$31.60	$31.60
	Available brands
	Humiraa

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
12425YMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12426BMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12428DMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	3	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12429EMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	3	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12430FMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12431GMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	0	$618.90	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12432HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	3	6	0	$1658.58	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12433JMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	3	6	0	$1658.58	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12434KMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12435LMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$622.92	$31.60	$31.60
	Available brands
	Amgevitaa

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
12436MMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$711.23	$31.60	$31.60
	Available brands
	Amgevita

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
12437NMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12438PMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
12439QMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$656.21	$31.60	$31.60
	Available brands
	Amgevitaa

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
12440RMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$711.23	$31.60	$31.60
	Available brands
	Amgevitaa

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
12442WMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	3	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12443XMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	0	$652.03	$31.60	$31.60
	Available brands
	Humiraa

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
12444YMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	0	$505.95	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12446CMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12447DMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	1	1	0	$676.79	$31.60	$31.60
	Available brands
	Humira

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
12448EMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	2	2	5	$1345.59	$31.60	$31.60
	Available brands
	Humira

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
12449FMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	2	2	2	$1345.59	$31.60	$31.60
	Available brands
	Humira

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
12450GMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
12451HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	2	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12453KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	3	6	0	$2014.38	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12454LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	3	6	0	$1658.58	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12455MMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	3	6	0	$2014.38	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
12524EMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	3	3	0	$2014.38	$31.60	$31.60
	Available brands
	Humira

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
13208EMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13209FMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

Source	S100 HSD Private
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
13210GMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$652.03	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
13211HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

Source	S100 HSD Public
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
13212JMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$505.95	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
13213KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13214LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13215MMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13216NMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13217PMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13218QMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13219RMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13220TMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13221WMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	2	4	5	$1108.39	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13222XMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$676.79	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
13223YMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13224BMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13225CMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13226DMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
13227EMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

Source	S100 HSD Public
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
13228FMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$618.90	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

Source	S100 HSD Private
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
13229GMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$534.56	$31.60	$31.60
	Available brands
	Adalicipa
	Humiraa
	Yuflymaa

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
13230HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$558.19	$31.60	$31.60
	Available brands
	Adalicipa
	Yuflymaa

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
5281YMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
5282BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
5283CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
5284DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
8737WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
8741CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
8963RMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
8964TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
8965WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
8966XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9033KMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9034LMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9077RMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9078TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9099XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9100YMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9101BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9102CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9103DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	3	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9104EMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9188NMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9189PMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9190QMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	2	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9191RMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9425CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	4	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9426DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	4	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9427EMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9428FMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$681.01	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9662MMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	0	$622.92	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9663NMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	0	$622.92	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9679KMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	0	$656.21	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa

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
9680LMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	0	$656.21	$31.60	$31.60
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza
	Idacioa