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
10184BMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.49	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

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
10196PMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

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
11459DMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$186.16	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

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
11461FMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$930.80	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

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
11796WMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	5	5	2	$976.93	$31.60	$31.60
	Available brands
	Inflectraa
	Renflexisa

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
11797XMP	INFLIXIMAB infliximab 100 mg injection, 1 vial (PI, CMI)	1	1	0	$202.49	$31.60	$31.60
	Available brands
	Inflectraa
	Remicadea
	Renflexisa

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
12550MMP	INFLIXIMAB infliximab 120 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	0	$760.24	$31.60	$31.60
	Available brands
	Remsima SC

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
12552PMP	INFLIXIMAB infliximab 120 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$760.24	$31.60	$31.60
	Available brands
	Remsima SC

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
12556WMP	TOFACITINIB tofacitinib 5 mg tablet, 56 (PI, CMI)	1	56	3	$1212.73	$31.60	$31.60
	Available brands
	Xeljanz

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
12557XMP	TOFACITINIB tofacitinib 5 mg tablet, 56 (PI, CMI)	1	56	5	$1212.73	$31.60	$31.60
	Available brands
	Xeljanz

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
12561DMP	INFLIXIMAB infliximab 120 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$760.24	$31.60	$31.60
	Available brands
	Remsima SC

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
12575WMP	INFLIXIMAB infliximab 120 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	2	$578.68	$31.60	$31.60
	Available brands
	Remsima SC

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
12584HMP	INFLIXIMAB infliximab 120 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	0	$578.68	$31.60	$31.60
	Available brands
	Remsima SC

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
12587LMP	INFLIXIMAB infliximab 120 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	5	$578.68	$31.60	$31.60
	Available brands
	Remsima SC

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
12588MMP	TOFACITINIB tofacitinib 10 mg tablet, 56 (PI, CMI)	1	56	3	$1981.28	$31.60	$31.60
	Available brands
	Xeljanz

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
12589NMP	TOFACITINIB tofacitinib 10 mg tablet, 56 (PI, CMI)	1	56	5	$1981.28	$31.60	$31.60
	Available brands
	Xeljanz

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
13249HMP	UPADACITINIB upadacitinib 30 mg modified release tablet, 28 (PI, CMI)	1	28	5	$2078.09	$31.60	$31.60
	Available brands
	Rinvoq

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
13250JMP	UPADACITINIB upadacitinib 15 mg modified release tablet, 28 (PI, CMI)	1	28	5	$1273.11	$31.60	$31.60
	Available brands
	Rinvoq

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
13251KMP	OZANIMOD ozanimod 230 microgram capsule [4] (&) ozanimod 460 microgram capsule [3], 7 (PI, CMI)	1	1	0	$589.72	$31.60	$31.60
	Available brands
	Zeposia

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
13255PMP	USTEKINUMAB ustekinumab 130 mg/26 mL injection, 26 mL vial (PI, CMI)	4	4	0	$2291.80	$31.60	$31.60
	Available brands
	Stelaraa
	Steqeymaa

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
13256QMP	UPADACITINIB upadacitinib 15 mg modified release tablet, 28 (PI, CMI)	1	28	1	$1273.11	$31.60	$31.60
	Available brands
	Rinvoq

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
13261YMP	USTEKINUMAB ustekinumab 90 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	1	$1002.28	$31.60	$31.60
	Available brands
	Stelaraa
	Steqeymaa

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
13262BMP	UPADACITINIB upadacitinib 45 mg modified release tablet, 28 (PI, CMI)	1	28	3	$2717.78	$31.60	$31.60
	Available brands
	Rinvoq

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
13265EMP	UPADACITINIB upadacitinib 30 mg modified release tablet, 28 (PI, CMI)	1	28	1	$2078.09	$31.60	$31.60
	Available brands
	Rinvoq

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
13269JMP	OZANIMOD ozanimod 920 microgram capsule, 28 (PI, CMI)	1	28	5	$2221.22	$31.60	$31.60
	Available brands
	Zeposia

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
13271LMP	OZANIMOD ozanimod 920 microgram capsule, 28 (PI, CMI)	1	28	3	$2221.22	$31.60	$31.60
	Available brands
	Zeposia

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
13272MMP	USTEKINUMAB ustekinumab 130 mg/26 mL injection, 26 mL vial (PI, CMI)	4	4	0	$2242.92	$31.60	$31.60
	Available brands
	Stelaraa
	Steqeymaa

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
13273NMP	USTEKINUMAB ustekinumab 90 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	0	$1002.28	$31.60	$31.60
	Available brands
	Stelaraa
	Steqeymaa

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
14600KMP	ETRASIMOD etrasimod 2 mg tablet, 28 (PI, CMI)	1	28	3	$1434.40	$31.60	$31.60
	Available brands
	Velsipity

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
14601LMP	ETRASIMOD etrasimod 2 mg tablet, 28 (PI, CMI)	1	28	5	$1434.40	$31.60	$31.60
	Available brands
	Velsipity

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
14918EMP	USTEKINUMAB ustekinumab 90 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	1	$1002.28	$31.60	$31.60
	Available brands
	Steqeyma