Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
10505XMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	5	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
11991DMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	2	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12131LMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	2	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12132MMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12141BMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12152NMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12153PMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13138LMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	2	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13139MMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13141PMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13146XMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	2	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13150DMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13151EMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	2	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13164WMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	5	$315.15	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13167BMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
14594DMP	AFLIBERCEPT aflibercept 8 mg/0.07 mL injection, 0.07 mL vial (PI, CMI)	1	1	2	$456.64	$25.00	$25.00
	Available brands
	Eylea

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
14626TMP	AFLIBERCEPT aflibercept 8 mg/0.07 mL injection, 0.07 mL vial (PI, CMI)	1	1	2	$456.64	$25.00	$25.00
	Available brands
	Eylea

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
14627WMP	AFLIBERCEPT aflibercept 8 mg/0.07 mL injection, 0.07 mL vial (PI, CMI)	1	1	5	$456.64	$25.00	$25.00
	Available brands
	Eylea

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
14635GMP	AFLIBERCEPT aflibercept 8 mg/0.07 mL injection, 0.07 mL vial (PI, CMI)	1	1	5	$456.64	$25.00	$25.00
	Available brands
	Eylea

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15206HMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15207JMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15213QMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15214RMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15215TMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15217XMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15218YMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15219BMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
2168DMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL vial (PI, CMI)	1	1	2	$315.15	$25.00	$25.00
	Available brands
	Eyleaa