LANREOTIDE

LANREOTIDE (11289E)

lanreotide 120 mg/0.5 mL injection, 0.5 mL syringe
11289E
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16024)

Indication: Acromegaly
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 16055)

Indication: Acromegaly
Treatment phase: Continuing treatment

Restriction (Streamlined authority code: 16057)

Indication: Functional carcinoid tumour
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 15955)

Indication: Functional carcinoid tumour
Treatment phase: Continuing treatment
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: $2,630.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mytolac
Somatuline Autogel

LANREOTIDE (11513Y)

lanreotide 120 mg/0.5 mL injection, 0.5 mL syringe
11513Y
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17635)

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: $2,581.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mytolac
Somatuline Autogel

LANREOTIDE (11527Q)

lanreotide 120 mg/0.5 mL injection, 0.5 mL syringe
11527Q
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17637)

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: $2,630.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mytolac
Somatuline Autogel

LANREOTIDE (11736Q)

lanreotide 120 mg/0.5 mL injection, 0.5 mL syringe
11736Q
Body System:
Manner of administration:Injection
S100 HSD Community Access
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17638)

Indication: Non-functional gastroenteropancreatic neuroendocrine tumour (GEP-NET)
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 17696)

Indication: Non-functional gastroenteropancreatic neuroendocrine tumour (GEP-NET)
Treatment phase: Continuing treatment
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: $2,630.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mytolac
Somatuline Autogel

LANREOTIDE (5779E)

lanreotide 120 mg/0.5 mL injection, 0.5 mL syringe
5779E
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7025)

Indication: Acromegaly

Restriction (Streamlined authority code: 4575)

Indication: Functional carcinoid tumour
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: $2,581.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mytolac
Somatuline Autogel

LANREOTIDE (6425E)

lanreotide 120 mg/0.5 mL injection, 0.5 mL syringe
6425E
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9261)

Indication: Acromegaly

Restriction (Streamlined authority code: 9260)

Indication: Functional carcinoid tumour
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: $2,630.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mytolac
Somatuline Autogel