AFLIBERCEPT

AFLIBERCEPT (15220C)

aflibercept 8 mg/0.07 mL injection, 0.07 mL syringe
15220C
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: $440.71 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (15221D)

aflibercept 8 mg/0.07 mL injection, 0.07 mL syringe
15221D
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: $440.71 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (15248M)

aflibercept 8 mg/0.07 mL injection, 0.07 mL syringe
15248M
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: $440.71 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea

AFLIBERCEPT (15260E)

aflibercept 8 mg/0.07 mL injection, 0.07 mL syringe
15260E
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: $440.71 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Eylea