Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

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
11138FMP	VORINOSTAT vorinostat 100 mg capsule, 120 (PI, CMI)	1	120	2	$4,249.94	$25.00	$25.00
	Available brands
	Zolinza

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

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
11141JMP	VORINOSTAT vorinostat 100 mg capsule, 120 (PI, CMI)	1	120	1	$4,249.94	$25.00	$25.00
	Available brands
	Zolinza

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
11651FMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	180 mg	3	$18,073.54	$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
11660QMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	180 mg	3	$17,780.23	$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
11661RMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	180 mg	11	$18,073.54	$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
11664XMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	180 mg	11	$17,780.23	$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
12632WMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	200 mg	1	$18,073.54	$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
12646NMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	200 mg	5	$17,780.23	$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
12656DMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	200 mg	5	$18,073.54	$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
12657EMP	BRENTUXIMAB VEDOTIN Injection (PI, CMI) Available brands Adcetris (brentuximab vedotin 50 mg injection, 1 vial)	200 mg	1	$17,780.23	$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
15271RMP	MOGAMULIZUMAB Injection (PI, CMI) Available brands POTELIGEO (mogamulizumab 20 mg/5 mL injection, 5 mL vial)	120 mg	7	$13,189.23	$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
15277CMP	MOGAMULIZUMAB Injection (PI, CMI) Available brands POTELIGEO (mogamulizumab 20 mg/5 mL injection, 5 mL vial)	120 mg	7	$13,418.26	$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
15306NMP	MOGAMULIZUMAB Injection (PI, CMI) Available brands POTELIGEO (mogamulizumab 20 mg/5 mL injection, 5 mL vial)	120 mg	3	$13,418.26	$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
15318FMP	MOGAMULIZUMAB Injection (PI, CMI) Available brands POTELIGEO (mogamulizumab 20 mg/5 mL injection, 5 mL vial)	120 mg	3	$13,189.23	$25.00	$25.00