Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5637QMP	DARBEPOETIN ALFA darbepoetin alfa 10 microgram/0.4 mL injection, 4 x 0.4 mL syringes (PI, CMI)	2	8	5	$224.36	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5638RMP	DARBEPOETIN ALFA darbepoetin alfa 20 microgram/0.5 mL injection, 4 x 0.5 mL syringes (PI, CMI)	2	8	5	$422.54	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5639TMP	DARBEPOETIN ALFA darbepoetin alfa 30 microgram/0.3 mL injection, 4 x 0.3 mL syringes (PI, CMI)	2	8	5	$578.08	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5640WMP	DARBEPOETIN ALFA darbepoetin alfa 40 microgram/0.4 mL injection, 4 x 0.4 mL syringes (PI, CMI)	2	8	5	$701.66	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5641XMP	DARBEPOETIN ALFA darbepoetin alfa 50 microgram/0.5 mL injection, 4 x 0.5 mL syringes (PI, CMI)	2	8	5	$867.48	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5642YMP	DARBEPOETIN ALFA darbepoetin alfa 60 microgram/0.3 mL injection, 4 x 0.3 mL syringes (PI, CMI)	2	8	5	$1,018.64	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5643BMP	DARBEPOETIN ALFA darbepoetin alfa 150 microgram/0.3 mL injection, 4 x 0.3 mL syringes (PI, CMI)	2	8	5	$2,460.18	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5644CMP	DARBEPOETIN ALFA darbepoetin alfa 80 microgram/0.4 mL injection, 4 x 0.4 mL syringes (PI, CMI)	2	8	5	$1,340.82	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5645DMP	DARBEPOETIN ALFA darbepoetin alfa 20 microgram/0.5 mL injection, 0.5 mL pen device (PI, CMI)	8	8	5	$422.56	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5646EMP	DARBEPOETIN ALFA darbepoetin alfa 40 microgram/0.4 mL injection, 0.4 mL pen device (PI, CMI)	8	8	5	$701.60	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5647FMP	DARBEPOETIN ALFA darbepoetin alfa 60 microgram/0.3 mL injection, 0.3 mL pen device (PI, CMI)	8	8	5	$1,018.64	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5648GMP	DARBEPOETIN ALFA darbepoetin alfa 80 microgram/0.4 mL injection, 0.4 mL pen device (PI, CMI)	8	8	5	$1,340.88	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5649HMP	DARBEPOETIN ALFA darbepoetin alfa 100 microgram/0.5 mL injection, 0.5 mL pen device (PI, CMI)	8	8	5	$1,651.12	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5650JMP	DARBEPOETIN ALFA darbepoetin alfa 150 microgram/0.3 mL injection, 0.3 mL pen device (PI, CMI)	8	8	5	$2,460.16	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5651KMP	DARBEPOETIN ALFA darbepoetin alfa 100 microgram/0.5 mL injection, 4 x 0.5 mL syringes (PI, CMI)	2	8	5	$1,651.16	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6320PMP	DARBEPOETIN ALFA darbepoetin alfa 10 microgram/0.4 mL injection, 4 x 0.4 mL syringes (PI, CMI)	2	8	5	$242.22	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6321QMP	DARBEPOETIN ALFA darbepoetin alfa 20 microgram/0.5 mL injection, 4 x 0.5 mL syringes (PI, CMI)	2	8	5	$448.32	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6322RMP	DARBEPOETIN ALFA darbepoetin alfa 30 microgram/0.3 mL injection, 4 x 0.3 mL syringes (PI, CMI)	2	8	5	$610.08	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6323TMP	DARBEPOETIN ALFA darbepoetin alfa 40 microgram/0.4 mL injection, 4 x 0.4 mL syringes (PI, CMI)	2	8	5	$738.60	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6324WMP	DARBEPOETIN ALFA darbepoetin alfa 50 microgram/0.5 mL injection, 4 x 0.5 mL syringes (PI, CMI)	2	8	5	$911.06	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6325XMP	DARBEPOETIN ALFA darbepoetin alfa 60 microgram/0.3 mL injection, 4 x 0.3 mL syringes (PI, CMI)	2	8	5	$1,067.52	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6326YMP	DARBEPOETIN ALFA darbepoetin alfa 100 microgram/0.5 mL injection, 4 x 0.5 mL syringes (PI, CMI)	2	8	5	$1,700.04	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6365BMP	DARBEPOETIN ALFA darbepoetin alfa 150 microgram/0.3 mL injection, 4 x 0.3 mL syringes (PI, CMI)	2	8	5	$2,509.06	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6438WMP	DARBEPOETIN ALFA darbepoetin alfa 80 microgram/0.4 mL injection, 4 x 0.4 mL syringes (PI, CMI)	2	8	5	$1,389.70	$25.00	$25.00
	Available brands
	Aranesp

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6488LMP	DARBEPOETIN ALFA darbepoetin alfa 20 microgram/0.5 mL injection, 0.5 mL pen device (PI, CMI)	8	8	5	$448.32	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6489MMP	DARBEPOETIN ALFA darbepoetin alfa 40 microgram/0.4 mL injection, 0.4 mL pen device (PI, CMI)	8	8	5	$738.56	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6490NMP	DARBEPOETIN ALFA darbepoetin alfa 60 microgram/0.3 mL injection, 0.3 mL pen device (PI, CMI)	8	8	5	$1,067.52	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6491PMP	DARBEPOETIN ALFA darbepoetin alfa 80 microgram/0.4 mL injection, 0.4 mL pen device (PI, CMI)	8	8	5	$1,389.76	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6492QMP	DARBEPOETIN ALFA darbepoetin alfa 100 microgram/0.5 mL injection, 0.5 mL pen device (PI, CMI)	8	8	5	$1,700.00	$25.00	$25.00
	Available brands
	Aranesp SureClick

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6493RMP	DARBEPOETIN ALFA darbepoetin alfa 150 microgram/0.3 mL injection, 0.3 mL pen device (PI, CMI)	8	8	5	$2,509.04	$25.00	$25.00
	Available brands
	Aranesp SureClick