Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11163MMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$443.74	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11168TMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$418.14	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11175EMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$443.74	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11176FMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$418.14	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14895YMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	2	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14903JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	2	$443.74	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14911TMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$443.74	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14913XMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	5	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14930TMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	5	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14937EMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	5	$418.14	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14938FMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	5	$443.74	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14940HMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	2	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14945NMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	2	2	2	$418.14	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
14946PMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$418.14	$31.60	$31.60
	Available brands
	Omlyclo