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

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
12771EMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	2	$837.62	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

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
12784WMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	2	$878.90	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13028QMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	5	$837.62	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13033YMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	5	$878.90	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13036DMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	2	$837.62	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13038FMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	2	$878.90	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13039GMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	2	$878.90	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13040HMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	5	$878.90	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13042KMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	2	$837.62	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea

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

Caution

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
13044MMP	AZACITIDINE azacitidine 100 mg injection, 1 vial (PI, CMI)	14	14	5	$837.62	$30.00	$30.00
	Available brands
	AZACITIDINE DR.REDDY'Sa
	Azacitidine Accorda
	Azacitidine Junoa
	Azacitidine MSNa
	Azacitidine-Tevaa
	Azadinea