Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14876YMPNP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	8	56	5	$10116.32	$31.60	$31.60
	Available brands
	Vyalev

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14886LMP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	8	56	5	$10116.32	$31.60	$31.60
	Available brands
	Vyalev

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14887MMP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	4	28	5	$5112.56	$31.60	$31.60
	Available brands
	Vyalev

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14888NMP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	4	28	5	$5025.56	$31.60	$31.60
	Available brands
	Vyalev

Source	General Schedule
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14896BMPNP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	4	28	5	$5112.56	$31.60	$31.60
	Available brands
	Vyalev

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14914YMP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	4	28	5	$4976.68	$31.60	$31.60
	Available brands
	Vyalev

Source	S100 HSD Private
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14915BMP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	8	56	5	$10002.24	$31.60	$31.60
	Available brands
	Vyalev

Source	S100 HSD Public
Body System	NERVOUS SYSTEM > ANTI-PARKINSON DRUGS > DOPAMINERGIC AGENTS

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
14924LMP	FOSLEVODOPA + FOSCARBIDOPA foslevodopa 2.4 g/10 mL + foscarbidopa 120 mg/10 mL injection, 7 x 10 mL vials (PI, CMI)	8	56	5	$9953.36	$31.60	$31.60
	Available brands
	Vyalev