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
10384MMP	VEDOLIZUMAB vedolizumab 300 mg injection, 1 vial (PI, CMI)	1	1	0	$2949.93	$31.60	$31.60
	Available brands
	Entyvio

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
10398GMP	VEDOLIZUMAB vedolizumab 300 mg injection, 1 vial (PI, CMI)	1	1	0	$2998.60	$31.60	$31.60
	Available brands
	Entyvio

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
10944BMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	2	$558.66	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
10955NMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	2	$558.66	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
10960WMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$558.66	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
10961XMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$558.66	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
11381BMP	GOLIMUMAB golimumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$1124.06	$31.60	$31.60
	Available brands
	Simponi

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
11382CMP	GOLIMUMAB golimumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	3	3	0	$3295.89	$31.60	$31.60
	Available brands
	Simponi

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
11502JMP	GOLIMUMAB golimumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	1	$1124.06	$31.60	$31.60
	Available brands
	Simponi

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
12325QMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$558.66	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
12333DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	3	6	0	$1659.06	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
12334EMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$558.66	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
12337HMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	5	$649.05	$31.60	$31.60
	Available brands
	Humiraa

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
12339KMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL syringe (PI, CMI)	3	3	0	$2014.86	$31.60	$31.60
	Available brands
	Humiraa
	Yuflymaa

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
12347WMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	3	6	0	$1464.45	$31.60	$31.60
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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	$624.51	$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	$624.51	$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	$624.51	$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
12358KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$493.79	$31.60	$31.60
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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
12359LMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	2	$493.79	$31.60	$31.60
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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
12370CMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	3	6	0	$1659.06	$31.60	$31.60
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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
12371DMP	ADALIMUMAB adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes (PI, CMI)	1	2	3	$649.05	$31.60	$31.60
	Available brands
	Humiraa

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
12374GMP	ADALIMUMAB adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device (PI, CMI)	3	3	0	$2014.86	$31.60	$31.60
	Available brands
	Humiraa
	Hyrimoza
	Yuflymaa

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
12382QMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	3	6	0	$1464.45	$31.60	$31.60
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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
12391EMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$493.79	$31.60	$31.60
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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
12412GMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	2	$493.79	$31.60	$31.60
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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
13211HMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$493.79	$31.60	$31.60
	Available brands
	Hadlimaa
	Hyrimoza
	Yuflymaa

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
13213KMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$493.79	$31.60	$31.60
	Available brands
	Hadlimaa
	Hyrimoza
	Yuflymaa

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
14253EMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$624.52	$31.60	$31.60
	Available brands
	Abriladaa

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
14273FMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	3	$624.52	$31.60	$31.60
	Available brands
	Abriladaa

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
14294HMP	ADALIMUMAB adalimumab 20 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$624.52	$31.60	$31.60
	Available brands
	Abriladaa