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	$1613.60	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$391.44	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$782.88	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$822.02	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$1613.60	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$391.44	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$1565.76	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$391.44	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$782.88	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	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	$1565.76	$30.00	$30.00
	Available brands
	CIPLA DEFERASIROXa
	DEFERASIROX-TEVAa
	Deferasirox ARXa
	Deferasirox Sandoza
	Eferasa
	Jadenua
	Pharmacor Deferasirox FCa