Source	S100 HSD Public
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
14856XMP	MARIBAVIR maribavir 200 mg tablet, 28 (PI, CMI)	4	112	1	$28200.00	$31.60	$31.60
	Available brands
	Livtencity

Source	S100 HSD Private
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
14865JMP	MARIBAVIR maribavir 200 mg tablet, 28 (PI, CMI)	4	112	1	$28248.88	$31.60	$31.60
	Available brands
	Livtencity

Source	S100 HSD Community Access
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
14866KMP	MARIBAVIR maribavir 200 mg tablet, 28 (PI, CMI)	4	112	1	$28248.88	$31.60	$31.60
	Available brands
	Livtencity