Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10109CMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	7	$209.07	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10110DMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	7	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10118MMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	7	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
10122RMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	7	$226.31	$31.60	$31.60
	Available brands
	Omlycloa

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

Caution

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
10956PMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	6	$117.60	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

Caution

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
10967FMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	6	$104.54	$31.60	$31.60
	Available brands
	Omlycloa
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

Caution

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
10968GMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	6	$226.31	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

Caution

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
10973MMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	6	$209.07	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11996JMP	BENRALIZUMAB benralizumab 30 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	2	$3194.33	$31.60	$31.60
	Available brands
	Fasenra Pen

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11997KMP	BENRALIZUMAB benralizumab 30 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	4	$3194.33	$31.60	$31.60
	Available brands
	Fasenra Pen

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
11999MMP	BENRALIZUMAB benralizumab 30 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$3194.33	$31.60	$31.60
	Available brands
	Fasenra Pen

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
12007YMP	MEPOLIZUMAB mepolizumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	7	$1556.10	$31.60	$31.60
	Available brands
	Nucala

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
12021QMP	MEPOLIZUMAB mepolizumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$1556.10	$31.60	$31.60
	Available brands
	Nucala

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
12043WMP	MEPOLIZUMAB mepolizumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$1604.98	$31.60	$31.60
	Available brands
	Nucala

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
12051GMP	MEPOLIZUMAB mepolizumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	7	$1604.98	$31.60	$31.60
	Available brands
	Nucala

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
12052HMP	MEPOLIZUMAB mepolizumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$1604.98	$31.60	$31.60
	Available brands
	Nucala

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
12064YMP	MEPOLIZUMAB mepolizumab 100 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$1556.10	$31.60	$31.60
	Available brands
	Nucala

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

Caution

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
14882GMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14883HMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$226.31	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14884JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	7	$209.07	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14885KMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	7	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14904KMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	7	$117.60	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14905LMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	0	$104.54	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14906MMP	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	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14912WMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	0	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14919FMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

Caution

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
14920GMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14921HMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	5	$117.60	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14922JMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$209.07	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14923KMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	7	$226.31	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14927PMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$226.31	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14928QMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$226.31	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14929RMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	0	$209.07	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14939GMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	0	$117.60	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14947QMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14948RMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	1	1	5	$209.07	$31.60	$31.60
	Available brands
	Omlyclo

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14949TMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	7	$104.54	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14950WMP	OMALIZUMAB omalizumab 75 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	5	$104.54	$31.60	$31.60
	Available brands
	Xolaira

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14951XMP	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	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14952YMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	0	$418.14	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14953BMP	OMALIZUMAB omalizumab 300 mg/2 mL injection, 2 mL pen device (PI, CMI)	1	1	7	$443.75	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14959HMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices (PI, CMI)	1	2	7	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14960JMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL syringes (PI, CMI)	1	2	3	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14961KMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL syringes (PI, CMI)	1	2	0	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14962LMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices (PI, CMI)	1	2	7	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14963MMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL pen devices (PI, CMI)	1	2	0	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14964NMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL pen devices (PI, CMI)	1	2	3	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14965PMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL pen devices (PI, CMI)	1	2	3	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14977GMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL syringes (PI, CMI)	1	2	0	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14978HMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL syringes (PI, CMI)	1	2	0	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14986RMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL syringes (PI, CMI)	1	2	2	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14987TMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices (PI, CMI)	1	2	0	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14988WMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL pen devices (PI, CMI)	1	2	2	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
14999KMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL syringes (PI, CMI)	1	2	7	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15000LMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL pen devices (PI, CMI)	1	2	0	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15011CMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices (PI, CMI)	1	2	5	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15012DMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices (PI, CMI)	1	2	5	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15021NMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL syringes (PI, CMI)	1	2	5	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15022PMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL pen devices (PI, CMI)	1	2	2	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15032EMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL syringes (PI, CMI)	1	2	3	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15033FMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL syringes (PI, CMI)	1	2	2	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15034GMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices (PI, CMI)	1	2	0	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15041PMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL syringes (PI, CMI)	1	2	7	$1609.86	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15042QMP	DUPILUMAB dupilumab 300 mg/2 mL injection, 2 x 2 mL syringes (PI, CMI)	1	2	0	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES > OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES

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
15043RMP	DUPILUMAB dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL syringes (PI, CMI)	1	2	5	$1658.74	$31.60	$31.60
	Available brands
	Dupixenta