ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Public
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
12936WMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 100 mg + tezacaftor 50 mg + ivacaftor 75 mg tablet [56] (&) ivacaftor 150 mg tablet [28], 84 (PI, CMI)
1 1 5 $21375.00 $31.60 $31.60
Available brands
Trikafta
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ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Private
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
12938YMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 100 mg + tezacaftor 50 mg + ivacaftor 75 mg tablet [56] (&) ivacaftor 150 mg tablet [28], 84 (PI, CMI)
1 1 5 $21423.67 $31.60 $31.60
Available brands
Trikafta
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ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Private
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
13266FMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 50 mg + tezacaftor 25 mg + ivacaftor 37.5 mg tablet [56] (&) ivacaftor 75 mg tablet [28], 84 (PI, CMI)
1 1 5 $21423.67 $31.60 $31.60
Available brands
Trikafta
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ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Public
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
13276RMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 50 mg + tezacaftor 25 mg + ivacaftor 37.5 mg tablet [56] (&) ivacaftor 75 mg tablet [28], 84 (PI, CMI)
1 1 5 $21375.00 $31.60 $31.60
Available brands
Trikafta
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ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Public
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
14227TMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 80 mg + tezacaftor 40 mg + ivacaftor 60 mg granules [28] (&) ivacaftor 59.5 mg granules [28], 56 (PI, CMI)
1 1 5 $21375.00 $31.60 $31.60
Available brands
Trikafta
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ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Public
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
14228WMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 100 mg + tezacaftor 50 mg + ivacaftor 75 mg granules [28] (&) ivacaftor 75 mg granules [28], 56 (PI, CMI)
1 1 5 $21375.00 $31.60 $31.60
Available brands
Trikafta
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ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Private
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
14279MMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 80 mg + tezacaftor 40 mg + ivacaftor 60 mg granules [28] (&) ivacaftor 59.5 mg granules [28], 56 (PI, CMI)
1 1 5 $21423.67 $31.60 $31.60
Available brands
Trikafta
space

ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR

Source S100 HSD Private
Body System RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS
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
14280NMP ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 100 mg + tezacaftor 50 mg + ivacaftor 75 mg granules [28] (&) ivacaftor 75 mg granules [28], 56 (PI, CMI)
1 1 5 $21423.67 $31.60 $31.60
Available brands
Trikafta
space


  • Legend
  • MPMedical Practitioner