Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
15204FMP	VANZACAFTOR + TEZACAFTOR + DEUTIVACAFTOR vanzacaftor 10 mg + tezacaftor 50 mg + deutivacaftor 125 mg tablet, 56 (PI, CMI)	1	56	5	$21,423.88	$25.00	$25.00
	Available brands
	Alyftrek

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
15205GMP	VANZACAFTOR + TEZACAFTOR + DEUTIVACAFTOR vanzacaftor 10 mg + tezacaftor 50 mg + deutivacaftor 125 mg tablet, 56 (PI, CMI)	1	56	5	$21,375.00	$25.00	$25.00
	Available brands
	Alyftrek

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
15211NMP	VANZACAFTOR + TEZACAFTOR + DEUTIVACAFTOR vanzacaftor 4 mg + tezacaftor 20 mg + deutivacaftor 50 mg tablet, 84 (PI, CMI)	1	84	5	$21,423.88	$25.00	$25.00
	Available brands
	Alyftrek

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
15216WMP	VANZACAFTOR + TEZACAFTOR + DEUTIVACAFTOR vanzacaftor 4 mg + tezacaftor 20 mg + deutivacaftor 50 mg tablet, 84 (PI, CMI)	1	84	5	$21,375.00	$25.00	$25.00
	Available brands
	Alyftrek