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
13860LMP	SIROLIMUS sirolimus 500 microgram tablet, 100 (PI, CMI)	2	200	3	$672.10	$25.00	$25.00
	Available brands
	Rapamune

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
13885TMP	SIROLIMUS sirolimus 1 mg/mL oral liquid, 60 mL (PI, CMI)	2	2	3	$1,035.86	$25.00	$25.00
	Available brands
	Rapamune

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
13886WMP	SIROLIMUS sirolimus 2 mg tablet, 100 (PI, CMI)	2	200	3	$2,513.06	$25.00	$25.00
	Available brands
	Rapamune

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
14072PMP	SIROLIMUS sirolimus 1 mg tablet, 100 (PI, CMI)	2	200	3	$1,299.42	$25.00	$25.00
	Available brands
	Rapamune

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
6436RMP	SIROLIMUS sirolimus 1 mg tablet, 100 (PI, CMI)	2	200	5	$1,223.92	$25.00	$25.00
	Available brands
	Rapamune

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
6437TMP	SIROLIMUS sirolimus 1 mg/mL oral liquid, 60 mL (PI, CMI)	2	2	5	$969.86	$25.00	$25.00
	Available brands
	Rapamune

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
6457WMP	SIROLIMUS sirolimus 2 mg tablet, 100 (PI, CMI)	2	200	5	$2,399.00	$25.00	$25.00
	Available brands
	Rapamune

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
8724EMP	SIROLIMUS sirolimus 1 mg tablet, 100 (PI, CMI)	1	100	3	$654.11	$25.00	$25.00
	Available brands
	Rapamune

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
8725FMP	SIROLIMUS sirolimus 1 mg/mL oral liquid, 60 mL (PI, CMI)	1	1	3	$522.32	$25.00	$25.00
	Available brands
	Rapamune

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
8833XMP	SIROLIMUS sirolimus 2 mg tablet, 100 (PI, CMI)	1	100	3	$1,271.03	$25.00	$25.00
	Available brands
	Rapamune

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
8984WMP	SIROLIMUS sirolimus 500 microgram tablet, 100 (PI, CMI)	1	100	3	$340.44	$25.00	$25.00
	Available brands
	Rapamune

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
9548MMP	SIROLIMUS sirolimus 2 mg tablet, 100 (PI, CMI)	2	200	5	$2,350.12	$25.00	$25.00
	Available brands
	Rapamune

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
9549NMP	SIROLIMUS sirolimus 1 mg tablet, 100 (PI, CMI)	2	200	5	$1,175.04	$25.00	$25.00
	Available brands
	Rapamune

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
9550PMP	SIROLIMUS sirolimus 1 mg/mL oral liquid, 60 mL (PI, CMI)	2	2	5	$924.02	$25.00	$25.00
	Available brands
	Rapamune

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
9747BMP	SIROLIMUS sirolimus 500 microgram tablet, 100 (PI, CMI)	2	200	5	$587.54	$25.00	$25.00
	Available brands
	Rapamune

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
9748CMP	SIROLIMUS sirolimus 500 microgram tablet, 100 (PI, CMI)	2	200	5	$619.92	$25.00	$25.00
	Available brands
	Rapamune