Source	S100 HSD Public
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11126NMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 10 x 5 mL ampoules (PI, CMI)	1	10	0	$762.70	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecala

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11128QMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 10 x 5 mL ampoules (PI, CMI)	1	10	0	$801.88	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecala

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11194EMP	BACLOFEN baclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule (PI, CMI)	2	2	0	$644.51	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecal

Source	S100 HSD Public
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
11195FMP	BACLOFEN baclofen 40 mg/20 mL intrathecal injection, 20 mL ampoule (PI, CMI)	2	2	0	$611.38	$31.60	$31.60
	Available brands
	Sintetica Baclofen Intrathecal

Source	General Schedule
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

Restricted Benefit

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
13359DMPNP	BACLOFEN baclofen 25 mg tablet, 100 (PI, CMI)	2	200	5	$57.09	$31.60	$31.60
	Available brands
	APO-Baclofena
	Clofen 25a
	Lioresal 25a
	Stelax 25a

Source	General Schedule
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

Restricted Benefit

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
13522QMPNP	BACLOFEN baclofen 10 mg tablet, 100 (PI, CMI)	2	200	5	$33.43	$31.60	$31.60
	Available brands
	APO-Baclofena
	Clofen 10a
	Lioresal 10a
	Stelax 10a

Source	General Schedule
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
2729PMPNP	BACLOFEN baclofen 10 mg tablet, 100 (PI, CMI)	1	100	5	$23.44	$24.89	$28.34
	Available brands
	APO-Baclofena
	Clofen 10a
	Lioresal 10a
	Stelax 10a

Source	General Schedule
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
2730QMPNP	BACLOFEN baclofen 25 mg tablet, 100 (PI, CMI)	1	100	5	$35.27	$31.60	$31.60
	Available brands
	APO-Baclofena
	Clofen 25a
	Lioresal 25a
	Stelax 25a

Source	S100 HSD Public
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
5617PMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule (PI, CMI)	10	10	0	$762.70	$31.60	$31.60
	Available brands
	Bacthecala
	Lioresal Intrathecala

Source	S100 HSD Private
Body System	MUSCULO-SKELETAL SYSTEM > MUSCLE RELAXANTS > MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS

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
6284RMP	BACLOFEN baclofen 10 mg/5 mL intrathecal injection, 5 mL ampoule (PI, CMI)	10	10	0	$801.87	$31.60	$31.60
	Available brands
	Bacthecala
	Lioresal Intrathecala