Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14113TMP	MAVACAMTEN mavacamten 5 mg capsule, 28 (PI, CMI)	1	28	5	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14117BMP	MAVACAMTEN mavacamten 5 mg capsule, 28 (PI, CMI)	1	28	2	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14123HMP	MAVACAMTEN mavacamten 2.5 mg capsule, 28 (PI, CMI)	1	28	5	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14124JMP	MAVACAMTEN mavacamten 15 mg capsule, 28 (PI, CMI)	1	28	5	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14135YMP	MAVACAMTEN mavacamten 2.5 mg capsule, 28 (PI, CMI)	1	28	2	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14137CMP	MAVACAMTEN mavacamten 10 mg capsule, 28 (PI, CMI)	1	28	2	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14138DMP	MAVACAMTEN mavacamten 10 mg capsule, 28 (PI, CMI)	1	28	5	$2323.63	$31.60	$31.60
	Available brands
	Camzyos

Source	General Schedule
Body System	CARDIOVASCULAR SYSTEM > CARDIAC THERAPY > OTHER CARDIAC PREPARATIONS

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
14139EMP	MAVACAMTEN mavacamten 15 mg capsule, 28 (PI, CMI)	1	28	2	$2323.63	$31.60	$31.60
	Available brands
	Camzyos