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
5794YMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 30 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$221.00	$25.00	$25.00
	Available brands
	Mircera

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
5795BMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 50 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$368.34	$25.00	$25.00
	Available brands
	Mircera

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
5796CMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 75 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$536.36	$25.00	$25.00
	Available brands
	Mircera

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
5797DMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 100 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$693.68	$25.00	$25.00
	Available brands
	Mircera

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
5798EMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 120 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$803.12	$25.00	$25.00
	Available brands
	Mircera

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
5799FMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 200 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$1,151.90	$25.00	$25.00
	Available brands
	Mircera

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
5800GMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 360 microgram/0.6 mL injection, 0.6 mL syringe (PI, CMI)	2	2	5	$1,991.30	$25.00	$25.00
	Available brands
	Mircera

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
9574XMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 30 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$238.72	$25.00	$25.00
	Available brands
	Mircera

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
9575YMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 50 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$391.96	$25.00	$25.00
	Available brands
	Mircera

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
9576BMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 75 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$566.70	$25.00	$25.00
	Available brands
	Mircera

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
9577CMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 100 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$730.30	$25.00	$25.00
	Available brands
	Mircera

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
9578DMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 120 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$844.12	$25.00	$25.00
	Available brands
	Mircera

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
9579EMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 200 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$1,200.78	$25.00	$25.00
	Available brands
	Mircera

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
9580FMPNP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 360 microgram/0.6 mL injection, 0.6 mL syringe (PI, CMI)	2	2	5	$2,040.18	$25.00	$25.00
	Available brands
	Mircera