Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
6208RMP	MYCOPHENOLATE mycophenolate mofetil 250 mg capsule, 100 (PI, CMI)	6	600	5	$128.70	$25.00	$25.00
	Available brands
	APO-Mycophenolatea
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 250a

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
6209TMP	MYCOPHENOLATE mycophenolate mofetil 500 mg tablet, 50 (PI, CMI)	6	300	5	$128.58	$25.00	$25.00
	Available brands
	ARX-MYCOPHENOLATEa
	Ceptolatea
	Mycophenolate GHa
	Mycophenolate Sandoza
	Pharmacor Mycophenolate 500a

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
6364YMP	MYCOPHENOLATE mycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL (PI, CMI)	2	2	5	$399.12	$25.00	$25.00
	Available brands
	CellCepta
	Pharmacor Mycophenolatea

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
6369FMP	MYCOPHENOLATE mycophenolate 180 mg enteric tablet, 120 (PI, CMI)	2	240	5	$187.32	$25.00	$25.00
	Available brands
	Mycophenolic Acid ARXa
	Myfortica

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

Note

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
6370GMP	MYCOPHENOLATE mycophenolate 360 mg enteric tablet, 120 (PI, CMI)	2	240	5	$280.46	$25.00	$25.00
	Available brands
	MYCOTEXa
	Mycophenolic Acid ARXa
	Myfortica