Source	S100 HSD Public
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11332KMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	1	$16846.67	$31.60	$31.60
	Available brands
	Maviret

Source	S100 HSD Public
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11333LMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	3	$16846.67	$31.60	$31.60
	Available brands
	Maviret

Source	S100 HSD Private
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11337QMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	3	$16895.34	$31.60	$31.60
	Available brands
	Maviret

Source	General Schedule
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11344CMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	3	$17009.27	$31.60	$31.60
	Available brands
	Maviret

Source	S100 HSD Public
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11345DMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	2	$16846.67	$31.60	$31.60
	Available brands
	Maviret

Source	S100 HSD Private
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11346EMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	2	$16895.34	$31.60	$31.60
	Available brands
	Maviret

Source	General Schedule
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11353MMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	1	$17009.27	$31.60	$31.60
	Available brands
	Maviret

Source	General Schedule
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11354NMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	2	$17009.27	$31.60	$31.60
	Available brands
	Maviret

Source	S100 HSD Private
Body System	ANTIINFECTIVES FOR SYSTEMIC USE > ANTIVIRALS FOR SYSTEMIC USE > DIRECT ACTING ANTIVIRALS

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
11355PMPNP	GLECAPREVIR + PIBRENTASVIR glecaprevir 100 mg + pibrentasvir 40 mg tablet, 84 (PI, CMI)	1	84	1	$16895.34	$31.60	$31.60
	Available brands
	Maviret