Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11628BMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial)	120 mg	3	$16,125.09	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
11644WMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial)	120 mg	3	$16,395.22	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12304NMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial)	120 mg	4	$16,395.22	$25.00	$25.00

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12322MMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial)	120 mg	4	$16,125.09	$25.00	$25.00

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12583GMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial)	120 mg	3	$16,125.09	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
12601FMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial)	120 mg	3	$16,395.22	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
2638WMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial) Yervoy (ipilimumab 200 mg/40 mL injection, 40 mL vial)	360 mg	3	$43,492.42	$25.00	$25.00

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
2641BMP	IPILIMUMAB Injection (PI, CMI) Available brands Yervoy (ipilimumab 50 mg/10 mL injection, 10 mL vial) Yervoy (ipilimumab 200 mg/40 mL injection, 40 mL vial)	360 mg	3	$42,848.19	$25.00	$25.00