Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11231DMP	DEFERASIROX deferasirox 500 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$2374.68	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11232EMP	DEFERASIROX deferasirox 500 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$2423.58	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11234GMP	DEFERASIROX deferasirox 500 mg dispersible tablet, 28 (PI, CMI)	6	168	5	$2374.68	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11235HMP	DEFERASIROX deferasirox 125 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$593.70	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11236JMP	DEFERASIROX deferasirox 125 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$626.34	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11238LMP	DEFERASIROX deferasirox 250 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$860.34	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11239MMP	DEFERASIROX deferasirox 250 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$818.70	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11240NMP	DEFERASIROX deferasirox 250 mg dispersible tablet, 28 (PI, CMI)	6	168	5	$818.70	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11241PMP	DEFERASIROX deferasirox 125 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$626.34	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11243RMP	DEFERASIROX deferasirox 500 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$2423.58	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11244TMP	DEFERASIROX deferasirox 250 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$860.34	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11247YMP	DEFERASIROX deferasirox 125 mg dispersible tablet, 28 (PI, CMI)	6	168	5	$593.70	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11496CMP	DEFERASIROX deferasirox 360 mg tablet, 30 (PI, CMI)	6	180	5	$371.04	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11499FMP	DEFERASIROX deferasirox 90 mg tablet, 30 (PI, CMI)	6	180	5	$87.06	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11500GMP	DEFERASIROX deferasirox 180 mg tablet, 30 (PI, CMI)	6	180	2	$174.12	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11510TMP	DEFERASIROX deferasirox 180 mg tablet, 30 (PI, CMI)	6	180	2	$189.96	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11511WMP	DEFERASIROX deferasirox 360 mg tablet, 30 (PI, CMI)	6	180	2	$371.04	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11519GMP	DEFERASIROX deferasirox 90 mg tablet, 30 (PI, CMI)	6	180	2	$87.06	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11533BMP	DEFERASIROX deferasirox 360 mg tablet, 30 (PI, CMI)	6	180	5	$348.24	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11534CMP	DEFERASIROX deferasirox 90 mg tablet, 30 (PI, CMI)	6	180	2	$87.06	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11535DMP	DEFERASIROX deferasirox 180 mg tablet, 30 (PI, CMI)	6	180	2	$174.12	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11536EMP	DEFERASIROX deferasirox 360 mg tablet, 30 (PI, CMI)	6	180	2	$348.24	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11545PMP	DEFERASIROX deferasirox 90 mg tablet, 30 (PI, CMI)	6	180	5	$99.96	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11546QMP	DEFERASIROX deferasirox 180 mg tablet, 30 (PI, CMI)	6	180	5	$189.96	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11547RMP	DEFERASIROX deferasirox 360 mg tablet, 30 (PI, CMI)	6	180	2	$371.04	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11548TMP	DEFERASIROX deferasirox 90 mg tablet, 30 (PI, CMI)	6	180	2	$99.96	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11555EMP	DEFERASIROX deferasirox 360 mg tablet, 30 (PI, CMI)	6	180	2	$348.24	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11556FMP	DEFERASIROX deferasirox 180 mg tablet, 30 (PI, CMI)	6	180	5	$174.12	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11557GMP	DEFERASIROX deferasirox 180 mg tablet, 30 (PI, CMI)	6	180	2	$189.96	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
11558HMP	DEFERASIROX deferasirox 90 mg tablet, 30 (PI, CMI)	6	180	2	$99.96	$31.60	$31.60
	Available brands
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
5654NMP	DEFERASIROX deferasirox 125 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$593.70	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
5655PMP	DEFERASIROX deferasirox 250 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$818.70	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Public
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
5656QMP	DEFERASIROX deferasirox 500 mg dispersible tablet, 28 (PI, CMI)	6	168	2	$2374.68	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
6499CMP	DEFERASIROX deferasirox 125 mg dispersible tablet, 28 (PI, CMI)	6	168	5	$626.34	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
6500DMP	DEFERASIROX deferasirox 250 mg dispersible tablet, 28 (PI, CMI)	6	168	5	$860.34	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa

Source	S100 HSD Private
Body System	VARIOUS > ALL OTHER THERAPEUTIC PRODUCTS > ALL OTHER THERAPEUTIC PRODUCTS

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
9600GMP	DEFERASIROX deferasirox 500 mg dispersible tablet, 28 (PI, CMI)	6	168	5	$2423.58	$31.60	$31.60
	Available brands
	Deferasirox Junoa
	Pharmacor Deferasiroxa