Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
10424PMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	200 mg	7	$7,503.74	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
10475HMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	200 mg	5	$7,503.74	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11352LMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11492WMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	200 mg	6	$7,503.74	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11632FMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12120XMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	200 mg	7	$7,503.74	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12121YMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	3	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12122BMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	2	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12123CMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	3	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12125EMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	3	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12126FMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12605KMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13114FMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13267GMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13287HMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13626EMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13645EMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	6	$14,870.58	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13739DMP	PEMBROLIZUMAB Injection (PI, CMI) Available brands Keytruda (pembrolizumab 100 mg/4 mL injection, 4 mL vial)	400 mg	7	$14,870.58	$25.00	$25.00