OCTREOTIDE

OCTREOTIDE (10543X)

octreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
10543X
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8161)

Indication: Acromegaly

Restriction (Streamlined authority code: 5901)

Indication: Functional carcinoid tumour

Restriction (Streamlined authority code: 5906)

Indication: Vasoactive intestinal peptide secreting tumour (VIPoma)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $789.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (10566D)

octreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
10566D
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9262)

Indication: Acromegaly

Restriction (Streamlined authority code: 9313)

Indication: Functional carcinoid tumour

Restriction (Streamlined authority code: 9288)

Indication: Vasoactive intestinal peptide secreting tumour (VIPoma)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $829.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (11501H)

octreotide 10 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
11501H
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8197)

Indication: Acromegaly

Restriction (Streamlined authority code: 8208)

Indication: Functional carcinoid tumour

Restriction (Streamlined authority code: 8198)

Indication: Vasoactive intestinal peptide secreting tumour (VIPoma)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $829.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR