Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

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
11837BMP	AVANAFILR avanafil 50 mg tablet, 4 (PI, CMI)
	Available brands
	Spedra	1	4	5	$52.17	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

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
11860FMP	AVANAFILR avanafil 200 mg tablet, 4 (PI, CMI)
	Available brands
	Spedra	1	4	5	$56.47	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > UROLOGICALS > UROLOGICALS

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
11861GMP	AVANAFILR avanafil 100 mg tablet, 4 (PI, CMI)
	Available brands
	Spedra	1	4	5	$54.32	$7.70	$7.70