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

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
10137MMP	CERTOLIZUMAB PEGOL certolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes (PI, CMI)	1	2	5	$1,012.68	$25.00	$25.00
	Available brands
	Cimzia

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

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
10890EMP	SECUKINUMAB secukinumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	4	4	0	$2,653.60	$25.00	$25.00
	Available brands
	Cosentyx

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

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
10893HMP	SECUKINUMAB secukinumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	2	$676.80	$25.00	$25.00
	Available brands
	Cosentyx

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

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
10897MMP	CERTOLIZUMAB PEGOL certolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes (PI, CMI)	1	2	2	$1,012.68	$25.00	$25.00
	Available brands
	Cimzia

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

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
10904XMP	CERTOLIZUMAB PEGOL certolizumab pegol 200 mg/mL injection, 2 x 1 mL syringes (PI, CMI)	3	6	0	$2,977.05	$25.00	$25.00
	Available brands
	Cimzia

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

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
10906BMP	SECUKINUMAB secukinumab 150 mg/mL injection, 1 mL pen device (PI, CMI)	1	1	5	$676.80	$25.00	$25.00
	Available brands
	Cosentyx

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

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
11318QMP	CERTOLIZUMAB PEGOL certolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices (PI, CMI)	1	2	2	$1,012.68	$25.00	$25.00
	Available brands
	Cimzia

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

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
11319RMP	CERTOLIZUMAB PEGOL certolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices (PI, CMI)	3	6	0	$2,977.05	$25.00	$25.00
	Available brands
	Cimzia

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

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
11320TMP	CERTOLIZUMAB PEGOL certolizumab pegol 200 mg/mL injection, 2 x 1 mL pen devices (PI, CMI)	1	2	5	$1,012.68	$25.00	$25.00
	Available brands
	Cimzia

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

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
11361YMP	GOLIMUMAB golimumab 50 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	3	$1,052.63	$25.00	$25.00
	Available brands
	Simponi

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

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
11376RMP	GOLIMUMAB golimumab 50 mg/0.5 mL injection, 0.5 mL pen device (PI, CMI)	1	1	5	$1,052.63	$25.00	$25.00
	Available brands
	Simponi

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

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
12209NMP	IXEKIZUMAB ixekizumab 80 mg/mL injection, 2 x 1 mL pen devices (PI, CMI)	1	2	2	$3,259.93	$25.00	$25.00
	Available brands
	Taltz

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

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
12217BMP	IXEKIZUMAB ixekizumab 80 mg/mL injection, 2 x 1 mL pen devices (PI, CMI)	1	2	1	$3,259.93	$25.00	$25.00
	Available brands
	Taltz

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

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
12361NMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	5	$494.12	$25.00	$25.00
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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

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
12363QMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	5	$494.12	$25.00	$25.00
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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

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
12376JMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices (PI, CMI)	1	2	3	$494.12	$25.00	$25.00
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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

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
12442WMP	ADALIMUMAB adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes (PI, CMI)	1	2	3	$494.12	$25.00	$25.00
	Available brands
	Hadlimaa
	Humiraa
	Hyrimoza
	Yuflymaa

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

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
12621GMP	UPADACITINIB upadacitinib 15 mg modified release tablet, 28 (PI, CMI)	1	28	5	$1,212.73	$25.00	$25.00
	Available brands
	Rinvoq

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

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
12625LMP	UPADACITINIB upadacitinib 15 mg modified release tablet, 28 (PI, CMI)	1	28	3	$1,212.73	$25.00	$25.00
	Available brands
	Rinvoq

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

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
13345JMP	TOFACITINIB tofacitinib 5 mg tablet, 56 (PI, CMI)	1	56	5	$1,155.38	$25.00	$25.00
	Available brands
	Xeljanz

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

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
13349NMP	TOFACITINIB tofacitinib 5 mg tablet, 56 (PI, CMI)	1	56	3	$1,155.38	$25.00	$25.00
	Available brands
	Xeljanz

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

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
3434RMP	GOLIMUMAB golimumab 50 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	3	$1,052.63	$25.00	$25.00
	Available brands
	Simponi

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

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
3436WMP	GOLIMUMAB golimumab 50 mg/0.5 mL injection, 0.5 mL syringe (PI, CMI)	1	1	5	$1,052.63	$25.00	$25.00
	Available brands
	Simponi

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

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
8778BMP	ETANERCEPT etanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack (PI, CMI)	2	2	3	$846.44	$25.00	$25.00
	Available brands
	Enbrel

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

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
8779CMP	ETANERCEPT etanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack (PI, CMI)	2	2	5	$846.44	$25.00	$25.00
	Available brands
	Enbrel

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

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
9077RMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	3	$494.12	$25.00	$25.00
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza

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

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
9078TMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL syringes (PI, CMI)	1	2	5	$494.12	$25.00	$25.00
	Available brands
	Amgevitaa
	Hadlimaa
	Hyrimoza

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

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
9085EMP	ETANERCEPT etanercept 50 mg/mL injection, 4 x 1 mL syringes (PI, CMI)	1	1	3	$846.42	$25.00	$25.00
	Available brands
	Brenzysa
	Enbrela
	Erelzia
	Nepextoa

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

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
9086FMP	ETANERCEPT etanercept 50 mg/mL injection, 4 x 1 mL syringes (PI, CMI)	1	1	5	$846.42	$25.00	$25.00
	Available brands
	Brenzysa
	Enbrela
	Erelzia
	Nepextoa

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

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
9103DMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	3	$494.12	$25.00	$25.00
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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

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
9104EMP	ADALIMUMAB adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices (PI, CMI)	1	2	5	$494.12	$25.00	$25.00
	Available brands
	Abriladaa
	Amgevitaa
	Hadlimaa
	Hyrimoza

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

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
9455PMP	ETANERCEPT etanercept 50 mg/mL injection, 4 x 1 mL pen devices (PI, CMI)	1	1	3	$846.42	$25.00	$25.00
	Available brands
	Brenzysa
	Enbrela
	Erelzia
	Nepextoa

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

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
9456QMP	ETANERCEPT etanercept 50 mg/mL injection, 4 x 1 mL pen devices (PI, CMI)	1	1	5	$846.42	$25.00	$25.00
	Available brands
	Brenzysa
	Enbrela
	Erelzia
	Nepextoa