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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	5	$890.17	$31.60	$31.60
	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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	5	$890.17	$31.60	$31.60
	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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	5	$890.17	$31.60	$31.60
	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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	5	$890.17	$31.60	$31.60
	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 3.6 mg/0.09 mL injection, 0.09 mL syringe (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	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
2168DMP	AFLIBERCEPT aflibercept 4 mg/0.1 mL injection, 0.1 mL vial (PI, CMI)	1	1	2	$890.17	$31.60	$31.60
	Available brands
	Eyleaa