RAVULIZUMAB
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15225HMP | RAVULIZUMAB ravulizumab 1.1 g/11 mL injection, 11 mL vial (PI, CMI) |
1 | 1 | 2 | $24,105.11 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15234TMP | RAVULIZUMAB ravulizumab 300 mg/3 mL injection, 3 mL vial (PI, CMI) |
1 | 1 | 2 | $6,623.00 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15235WMP | RAVULIZUMAB ravulizumab 300 mg/3 mL injection, 3 mL vial (PI, CMI) |
1 | 1 | 1 | $6,623.00 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15244HMP | RAVULIZUMAB ravulizumab 300 mg/3 mL injection, 3 mL vial (PI, CMI) |
1 | 1 | 2 | $6,574.12 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15245JMP | RAVULIZUMAB ravulizumab 300 mg/3 mL injection, 3 mL vial (PI, CMI) |
1 | 1 | 0 | $6,574.12 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15246KMP | RAVULIZUMAB ravulizumab 1.1 g/11 mL injection, 11 mL vial (PI, CMI) |
1 | 1 | 1 | $24,105.11 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15254WMP | RAVULIZUMAB ravulizumab 1.1 g/11 mL injection, 11 mL vial (PI, CMI) |
1 | 1 | 2 | $24,153.99 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15255XMP | RAVULIZUMAB ravulizumab 300 mg/3 mL injection, 3 mL vial (PI, CMI) |
1 | 1 | 1 | $6,574.12 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15258CMP | RAVULIZUMAB ravulizumab 1.1 g/11 mL injection, 11 mL vial (PI, CMI) |
1 | 1 | 0 | $24,105.11 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15259DMP | RAVULIZUMAB ravulizumab 1.1 g/11 mL injection, 11 mL vial (PI, CMI) |
1 | 1 | 0 | $24,153.99 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15263HMP | RAVULIZUMAB ravulizumab 300 mg/3 mL injection, 3 mL vial (PI, CMI) |
1 | 1 | 0 | $6,623.00 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
RAVULIZUMAB
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15264JMP | RAVULIZUMAB ravulizumab 1.1 g/11 mL injection, 11 mL vial (PI, CMI) |
1 | 1 | 1 | $24,153.99 | $25.00 | $25.00 |
| Available brands | |||||||
| Ultomiris |
ZILUCOPLAN
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
ZILUCOPLAN
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15284KMP | ZILUCOPLAN Zilucoplan 32.4 mg/0.81 mL injection, 28 x 0.81 mL syringes (PI, CMI) |
1 | 28 | 5 | $41,707.50 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
ZILUCOPLAN
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15286MMP | ZILUCOPLAN Zilucoplan 23 mg/0.574 mL injection, 28 x 0.574 mL syringes (PI, CMI) |
1 | 28 | 5 | $29,521.05 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15287NMP | ZILUCOPLAN Zilucoplan 32.4 mg/0.81 mL injection, 28 x 0.81 mL syringes (PI, CMI) |
1 | 28 | 2 | $41,658.62 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15294YMP | ZILUCOPLAN Zilucoplan 32.4 mg/0.81 mL injection, 28 x 0.81 mL syringes (PI, CMI) |
1 | 28 | 2 | $41,707.50 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
ZILUCOPLAN
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15303KMP | ZILUCOPLAN Zilucoplan 23 mg/0.574 mL injection, 28 x 0.574 mL syringes (PI, CMI) |
1 | 28 | 2 | $29,521.05 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15304LMP | ZILUCOPLAN Zilucoplan 23 mg/0.574 mL injection, 28 x 0.574 mL syringes (PI, CMI) |
1 | 28 | 2 | $29,569.93 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Private |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15315CMP | ZILUCOPLAN Zilucoplan 23 mg/0.574 mL injection, 28 x 0.574 mL syringes (PI, CMI) |
1 | 28 | 5 | $29,569.93 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
ZILUCOPLAN
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
ZILUCOPLAN
| Source | S100 HSD Public |
| Body System | ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 15325NMP | ZILUCOPLAN Zilucoplan 32.4 mg/0.81 mL injection, 28 x 0.81 mL syringes (PI, CMI) |
1 | 28 | 5 | $41,658.62 | $25.00 | $25.00 |
| Available brands | |||||||
| Zilbrysq |
- Legend
- MPMedical Practitioner
