Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
10994PMP	INCOBOTULINUMTOXINA incobotulinumtoxinA 100 units injection, 1 vial (PI, CMI)	4	4	0	$1402.64	$31.60	$31.60
	Available brands
	Xeomin

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
11005FMP	INCOBOTULINUMTOXINA incobotulinumtoxinA 100 units injection, 1 vial (PI, CMI)	4	4	0	$1402.64	$31.60	$31.60
	Available brands
	Xeomin

Source	S100 Botulinum Toxin Program
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, PERIPHERALLY ACTING AGENTS

Caution

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
12087EMP	INCOBOTULINUMTOXINA incobotulinumtoxinA 100 units injection, 1 vial (PI, CMI)	4	4	0	$1402.64	$31.60	$31.60
	Available brands
	Xeomin