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
5713QMPNP	EPOETIN ALFA epoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$2,442.22	$25.00	$25.00
	Available brands
	Eprex 20,000

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
5714RMPNP	EPOETIN ALFA epoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$175.98	$25.00	$25.00
	Available brands
	Eprex 1000

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
5715TMPNP	EPOETIN ALFA epoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$666.22	$25.00	$25.00
	Available brands
	Eprex 5000

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
5716WMPNP	EPOETIN ALFA epoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes (PI, CMI)	2	12	5	$790.84	$25.00	$25.00
	Available brands
	Eprex 6000

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
5717XMPNP	EPOETIN ALFA epoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes (PI, CMI)	2	12	5	$1,025.72	$25.00	$25.00
	Available brands
	Eprex 8000

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
5718YMPNP	EPOETIN ALFA epoetin alfa 40 000 units/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$790.12	$25.00	$25.00
	Available brands
	Eprex 40,000

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
5719BMPNP	EPOETIN ALFA epoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$325.64	$25.00	$25.00
	Available brands
	Eprex 2000

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
5720CMPNP	EPOETIN ALFA epoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes (PI, CMI)	2	12	5	$420.20	$25.00	$25.00
	Available brands
	Eprex 3000

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
5721DMPNP	EPOETIN ALFA epoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes (PI, CMI)	2	12	5	$535.14	$25.00	$25.00
	Available brands
	Eprex 4000

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
5722EMPNP	EPOETIN ALFA epoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes (PI, CMI)	2	12	5	$1,241.44	$25.00	$25.00
	Available brands
	Eprex 10000

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
6204MMPNP	EPOETIN ALFA epoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$347.54	$25.00	$25.00
	Available brands
	Eprex 2000

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
6205NMPNP	EPOETIN ALFA epoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes (PI, CMI)	2	12	5	$445.88	$25.00	$25.00
	Available brands
	Eprex 3000

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
6206PMPNP	EPOETIN ALFA epoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes (PI, CMI)	2	12	5	$565.42	$25.00	$25.00
	Available brands
	Eprex 4000

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
6207QMPNP	EPOETIN ALFA epoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes (PI, CMI)	2	12	5	$1,290.32	$25.00	$25.00
	Available brands
	Eprex 10000

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
6251BMPNP	EPOETIN ALFA epoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$191.90	$25.00	$25.00
	Available brands
	Eprex 1000

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
6302QMPNP	EPOETIN ALFA epoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$701.74	$25.00	$25.00
	Available brands
	Eprex 5000

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
6303RMPNP	EPOETIN ALFA epoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes (PI, CMI)	2	12	5	$831.36	$25.00	$25.00
	Available brands
	Eprex 6000

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
6305WMPNP	EPOETIN ALFA epoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes (PI, CMI)	2	12	5	$1,074.60	$25.00	$25.00
	Available brands
	Eprex 8000

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
6339PMPNP	EPOETIN ALFA epoetin alfa 40 000 units/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$830.60	$25.00	$25.00
	Available brands
	Eprex 40,000

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
6434PMPNP	EPOETIN ALFA epoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$2,491.10	$25.00	$25.00
	Available brands
	Eprex 20,000