Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10060LMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10064QMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10072DMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10078KMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12763RMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12802TMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12805YMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12810FMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13299YMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	2	2	5	$810.78	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13323FMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	2	2	5	$851.89	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13338BMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	5	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13339CMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	5	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13715WMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	5	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13731QMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	5	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
1464CMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$430.28	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
1482BMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
9659JMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$405.39	$31.60	$31.60
	Available brands
	Actemra

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Note

Authority Required

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
9673DMP	TOCILIZUMAB tocilizumab 400 mg/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$430.28	$31.60	$31.60
	Available brands
	Actemra