OCTREOTIDE

OCTREOTIDE (10550G)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
10550G
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8161)

Indication: Acromegaly
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: $1,207.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (10558Q)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
10558Q
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9262)

Indication: Acromegaly
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: $1,256.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (11512X)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
11512X
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8197)

Indication: Acromegaly
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: $1,308.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (11893Y)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
11893Y
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19562)

Indication: Non-functional gastroenteropancreatic neuroendocrine tumour (GEP-NET)
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: $1,207.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (11894B)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
11894B
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19538)

Indication: Non-functional gastroenteropancreatic neuroendocrine tumour (GEP-NET)
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: $1,256.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (11896D)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
11896D
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19565)

Indication: Non-functional gastroenteropancreatic neuroendocrine tumour (GEP-NET)
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: $1,308.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (15639D)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
15639D
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19543)

Indication: Functional carcinoid tumour

Restriction (Streamlined authority code: 19544)

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: $1,256.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (15647M)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
15647M
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19539)

Indication: Functional carcinoid tumour

Restriction (Streamlined authority code: 19549)

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: $1,207.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR

OCTREOTIDE (15669Q)

octreotide 30 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
15669Q
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19540)

Indication: Functional carcinoid tumour

Restriction (Streamlined authority code: 19533)

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: $1,308.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sandostatin LAR