Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
12609PMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	1	1	5	$10890.26	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
12610QMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	1	1	0	$10890.26	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
12959CMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	1	1	0	$10890.26	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
13632LMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	3	3	7	$32574.03	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
13639WMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	3	3	5	$32574.03	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
13646FMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	3	3	5	$32574.03	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
13647GMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	1	1	0	$10890.26	$31.60	$31.60
	Available brands
	Evrysdi

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM > OTHER DRUGS FOR DISORDERS OF THE MUSCULO-SKELETAL SYSTEM

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
13659XMP	RISDIPLAM risdiplam 750 microgram/mL powder for oral liquid, 80 mL (PI, CMI)	3	3	5	$32574.03	$31.60	$31.60
	Available brands
	Evrysdi