Source	S100 HSD Public
Body System	NERVOUS SYSTEM > OTHER NERVOUS SYSTEM DRUGS > OTHER NERVOUS SYSTEM DRUGS

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
14264RMP	PATISIRAN patisiran 10 mg/5 mL injection, 5 mL vial (PI, CMI)	3	3	7	$37,349.79	$25.00	$25.00
	Available brands
	Onpattro

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > OTHER NERVOUS SYSTEM DRUGS > OTHER NERVOUS SYSTEM DRUGS

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
14296KMP	PATISIRAN patisiran 10 mg/5 mL injection, 5 mL vial (PI, CMI)	3	3	7	$37,398.66	$25.00	$25.00
	Available brands
	Onpattro

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > OTHER NERVOUS SYSTEM DRUGS > OTHER NERVOUS SYSTEM DRUGS

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
14810LMP	VUTRISIRAN Vutrisiran 25 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	1	$114,121.96	$25.00	$25.00
	Available brands
	Amvuttra

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > OTHER NERVOUS SYSTEM DRUGS > OTHER NERVOUS SYSTEM DRUGS

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
14829LMP	VUTRISIRAN Vutrisiran 25 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	1	$114,170.84	$25.00	$25.00
	Available brands
	Amvuttra