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

Caution

Restricted Benefit

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
13856GMPNP	MYCOPHENOLATE mycophenolate 180 mg enteric tablet, 120 (PI, CMI)	2	240	5	$202.50	$31.60	$31.60
	Available brands
	Mycophenolic Acid ARXa
	Myfortica

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

Caution

Restricted Benefit

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
13884RMPNP	MYCOPHENOLATE mycophenolate mofetil 250 mg capsule, 100 (PI, CMI)	6	600	5	$138.84	$31.60	$31.60
	Available brands
	APO-Mycophenolatea
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 250a

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

Caution

Restricted Benefit

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
13938NMPNP	MYCOPHENOLATE mycophenolate 360 mg enteric tablet, 120 (PI, CMI)	2	240	5	$396.16	$31.60	$31.60
	Available brands
	MYCOTEXa
	Mycophenolic Acid ARXa
	Myfortica

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

Caution

Restricted Benefit

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
14000WMPNP	MYCOPHENOLATE mycophenolate mofetil 500 mg tablet, 50 (PI, CMI)	6	300	5	$138.72	$31.60	$31.60
	Available brands
	ARX-MYCOPHENOLATEa
	Ceptolatea
	Mycophenolate GHa
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 500a

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

Caution

Restricted Benefit

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
14071NMPNP	MYCOPHENOLATE mycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL (PI, CMI)	2	2	5	$564.04	$31.60	$31.60
	Available brands
	CellCepta
	Pharmacor Mycophenolatea

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

Caution

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
2150EMPNP	MYCOPHENOLATE mycophenolate 180 mg enteric tablet, 120 (PI, CMI)	1	120	5	$106.03	$31.60	$31.60
	Available brands
	Mycophenolic Acid ARXa
	Myfortica

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

Caution

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
2193KMPNP	MYCOPHENOLATE mycophenolate 360 mg enteric tablet, 120 (PI, CMI)	1	120	5	$202.47	$31.60	$31.60
	Available brands
	MYCOTEXa
	Mycophenolic Acid ARXa
	Myfortica

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

Caution

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
6208RMP	MYCOPHENOLATE mycophenolate mofetil 250 mg capsule, 100 (PI, CMI)	6	600	5	$128.70	$31.60	$31.60
	Available brands
	APO-Mycophenolatea
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 250a

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

Caution

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
6209TMP	MYCOPHENOLATE mycophenolate mofetil 500 mg tablet, 50 (PI, CMI)	6	300	5	$128.58	$31.60	$31.60
	Available brands
	ARX-MYCOPHENOLATEa
	Ceptolatea
	Mycophenolate GHa
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 500a

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

Caution

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
6364YMP	MYCOPHENOLATE mycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL (PI, CMI)	2	2	5	$520.62	$31.60	$31.60
	Available brands
	CellCepta
	Pharmacor Mycophenolatea

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

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
6369FMP	MYCOPHENOLATE mycophenolate 180 mg enteric tablet, 120 (PI, CMI)	2	240	5	$187.32	$31.60	$31.60
	Available brands
	Mycophenolic Acid ARXa
	Myfortica

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

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
6370GMP	MYCOPHENOLATE mycophenolate 360 mg enteric tablet, 120 (PI, CMI)	2	240	5	$365.72	$31.60	$31.60
	Available brands
	MYCOTEXa
	Mycophenolic Acid ARXa
	Myfortica

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

Caution

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
8649FMPNP	MYCOPHENOLATE mycophenolate mofetil 250 mg capsule, 100 (PI, CMI)	3	300	5	$75.72	$31.60	$31.60
	Available brands
	APO-Mycophenolatea
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 250a

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

Caution

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
8650GMPNP	MYCOPHENOLATE mycophenolate mofetil 500 mg tablet, 50 (PI, CMI)	3	150	5	$75.66	$31.60	$31.60
	Available brands
	ARX-MYCOPHENOLATEa
	Ceptolatea
	Mycophenolate GHa
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 500a

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

Caution

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
8651HMPNP	MYCOPHENOLATE mycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL (PI, CMI)	1	1	5	$288.00	$31.60	$31.60
	Available brands
	CellCepta
	Pharmacor Mycophenolatea

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

Caution

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
9500BMP	MYCOPHENOLATE mycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL (PI, CMI)	2	2	5	$489.02	$31.60	$31.60
	Available brands
	CellCepta
	Pharmacor Mycophenolatea

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

Caution

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
9501CMP	MYCOPHENOLATE mycophenolate mofetil 250 mg capsule, 100 (PI, CMI)	6	600	5	$115.20	$31.60	$31.60
	Available brands
	APO-Mycophenolatea
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 250a

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

Caution

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
9502DMP	MYCOPHENOLATE mycophenolate mofetil 500 mg tablet, 50 (PI, CMI)	6	300	5	$115.08	$31.60	$31.60
	Available brands
	ARX-MYCOPHENOLATEa
	Ceptolatea
	Mycophenolate GHa
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 500a

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

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
9503EMP	MYCOPHENOLATE mycophenolate 180 mg enteric tablet, 120 (PI, CMI)	2	240	5	$171.58	$31.60	$31.60
	Available brands
	Mycophenolic Acid ARXa
	Myfortica

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

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
9504FMP	MYCOPHENOLATE mycophenolate 360 mg enteric tablet, 120 (PI, CMI)	2	240	5	$343.12	$31.60	$31.60
	Available brands
	MYCOTEXa
	Mycophenolic Acid ARXa
	Myfortica