Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11163MMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$456.27	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11168TMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$430.38	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Private
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11175EMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$456.27	$31.60	$31.60
	Available brands
	Xolair

Source	S100 HSD Public
Body System	DERMATOLOGICALS > OTHER DERMATOLOGICAL PREPARATIONS > OTHER DERMATOLOGICAL PREPARATIONS

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
11176FMP	OMALIZUMAB omalizumab 150 mg/mL injection, 1 mL syringe (PI, CMI)	2	2	2	$430.38	$31.60	$31.60
	Available brands
	Xolair