Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12132MMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12141BMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12152NMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
12153PMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13139MMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13141PMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13150DMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
13167BMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Eyleaa

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15206HMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15207JMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15213QMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15214RMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15215TMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	5	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15217XMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15218YMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira

Source	General Schedule
Body System	SENSORY ORGANS > OPHTHALMOLOGICALS > OCULAR VASCULAR DISORDER AGENTS

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
15219BMP	AFLIBERCEPT aflibercept 2 mg/0.05 mL injection, 0.05 mL syringe (PI, CMI)	1	1	2	$313.09	$25.00	$25.00
	Available brands
	Afqlira