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
10068XMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.86	$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
10073EMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.86	$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
10077JMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$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
10081NMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$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
12775JMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$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
12787BMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.86	$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
12794JMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$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
12811GMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.86	$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
13304FMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	4	4	5	$328.76	$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
13311NMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	2	2	5	$179.63	$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
13315TMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	4	4	5	$350.59	$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
13324GMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	2	2	5	$164.38	$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
13690MMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	2	2	5	$164.38	$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
13696WMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	2	2	5	$179.63	$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
1419QMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.86	$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
1476QMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$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
9657GMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$82.19	$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
9671BMP	TOCILIZUMAB tocilizumab 80 mg/4 mL injection, 4 mL vial (PI, CMI)	1	1	0	$94.86	$31.60	$31.60
	Available brands
	Actemra