Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
15227KMP	GLOFITAMAB Injection (PI, CMI) Available brands Columvi (Glofitamab 10 mg/10 mL injection, 10 mL vial)	30000 mcg	10	$16,156.39	$25.00	$25.00

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
15228LMP	GLOFITAMAB Injection (PI, CMI) Available brands Columvi (Glofitamab 10 mg/10 mL injection, 10 mL vial)	10000 mcg	0	$5,357.33	$25.00	$25.00

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
15249NMP	GLOFITAMAB Injection (PI, CMI) Available brands Columvi (Glofitamab 10 mg/10 mL injection, 10 mL vial)	30000 mcg	10	$15,889.53	$25.00	$25.00

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
15250PMP	GLOFITAMAB Injection (PI, CMI) Available brands Columvi (Glofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial)	2500 mcg	0	$1,407.76	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
15266LMP	GLOFITAMAB Injection (PI, CMI) Available brands Columvi (Glofitamab 10 mg/10 mL injection, 10 mL vial)	10000 mcg	0	$5,476.73	$25.00	$25.00

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > MONOCLONAL ANTIBODIES AND ANTIBODY DRUG CONJUGATES

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
15269PMP	GLOFITAMAB Injection (PI, CMI) Available brands Columvi (Glofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial)	2500 mcg	0	$1,471.86	$25.00	$25.00