Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10614PMP	RUXOLITINIB ruxolitinib 5 mg tablet, 56 (PI, CMI)	2	112	0	$4912.94	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10615QMP	RUXOLITINIB ruxolitinib 15 mg tablet, 56 (PI, CMI)	1	56	5	$4912.93	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10616RMP	RUXOLITINIB ruxolitinib 5 mg tablet, 56 (PI, CMI)	2	112	5	$4912.94	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10617TMP	RUXOLITINIB ruxolitinib 20 mg tablet, 56 (PI, CMI)	1	56	5	$4912.93	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10618WMP	RUXOLITINIB ruxolitinib 20 mg tablet, 56 (PI, CMI)	1	56	0	$4912.93	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10619XMP	RUXOLITINIB ruxolitinib 15 mg tablet, 56 (PI, CMI)	1	56	0	$4912.93	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10913JMP	RUXOLITINIB ruxolitinib 10 mg tablet, 56 (PI, CMI)	1	56	0	$4912.93	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
10927DMP	RUXOLITINIB ruxolitinib 10 mg tablet, 56 (PI, CMI)	1	56	5	$4912.93	$31.60	$31.60
	Available brands
	Jakavi

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
14743YMP	MOMELOTINIB Momelotinib 100 mg tablet, 30 (PI, CMI)	1	30	5	$5800.71	$31.60	$31.60
	Available brands
	Omjjara

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
14744BMP	MOMELOTINIB Momelotinib 150 mg tablet, 30 (PI, CMI)	1	30	5	$5800.71	$31.60	$31.60
	Available brands
	Omjjara

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
14762YMP	MOMELOTINIB Momelotinib 150 mg tablet, 30 (PI, CMI)	1	30	0	$5800.71	$31.60	$31.60
	Available brands
	Omjjara

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
14763BMP	MOMELOTINIB Momelotinib 200 mg tablet, 30 (PI, CMI)	1	30	0	$5800.71	$31.60	$31.60
	Available brands
	Omjjara

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
14769HMP	MOMELOTINIB Momelotinib 100 mg tablet, 30 (PI, CMI)	1	30	0	$5800.71	$31.60	$31.60
	Available brands
	Omjjara

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > PROTEIN KINASE INHIBITORS

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
14770JMP	MOMELOTINIB Momelotinib 200 mg tablet, 30 (PI, CMI)	1	30	5	$5800.71	$31.60	$31.60
	Available brands
	Omjjara