Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12332CMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	3	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12349YMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$576.38	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12350BMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	3	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12351CMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12354FMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12357JMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12417MMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$545.68	$31.60	$31.60
	Available brands
	Amgevitaa

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12435LMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$545.68	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12436MMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12439QMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$576.38	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
12440RMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
14747EMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
14748FMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	6	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
14749GMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	0	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
14772LMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
14975EMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	4	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
14998JMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
15005RMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe (PI, CMI)	2	2	5	$624.84	$31.60	$31.60
	Available brands
	Amgevitaa