Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
15276BMP	ZILUCOPLAN Zilucoplan 16.6 mg/0.416 mL injection, 28 x 0.416 mL syringes (PI, CMI)	1	28	2	$21,395.05	$25.00	$25.00
	Available brands
	Zilbrysq

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
15285LMP	ZILUCOPLAN Zilucoplan 16.6 mg/0.416 mL injection, 28 x 0.416 mL syringes (PI, CMI)	1	28	5	$21,443.93	$25.00	$25.00
	Available brands
	Zilbrysq

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
15302JMP	ZILUCOPLAN Zilucoplan 16.6 mg/0.416 mL injection, 28 x 0.416 mL syringes (PI, CMI)	1	28	2	$21,443.93	$25.00	$25.00
	Available brands
	Zilbrysq

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

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
15316DMP	ZILUCOPLAN Zilucoplan 16.6 mg/0.416 mL injection, 28 x 0.416 mL syringes (PI, CMI)	1	28	5	$21,395.05	$25.00	$25.00
	Available brands
	Zilbrysq