AFLIBERCEPT

AFLIBERCEPT (10505X)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
10505X
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Diabetic macular oedema (DMO)
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (11991D)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
11991D
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Branch retinal vein occlusion with macular oedema
Treatment phase: Initial treatment

Restriction

Indication: Central retinal vein occlusion with macular oedema
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 2 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (12131L)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
12131L
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Subfoveal choroidal neovascularisation (CNV)
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 2 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (13138L)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
13138L
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13387)

Indication: Branch retinal vein occlusion with macular oedema
Treatment phase: Continuing treatment

Restriction (Streamlined authority code: 13336)

Indication: Central retinal vein occlusion with macular oedema
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 2 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (13146X)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
13146X
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13406)

Indication: Subfoveal choroidal neovascularisation (CNV)
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 2 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (13151E)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
13151E
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13392)

Indication: Subfoveal choroidal neovascularisation (CNV)
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 2 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (13164W)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
13164W
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13402)

Indication: Diabetic macular oedema (DMO)
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (2168D)

aflibercept 2 mg/0.05 mL injection, 0.05 mL vial
2168D
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Subfoveal choroidal neovascularisation (CNV)
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 2 DPMQ: $315.15 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea