Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Public
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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

Source	S100 HSD Private
Body System	RESPIRATORY SYSTEM > OTHER RESPIRATORY SYSTEM PRODUCTS > OTHER RESPIRATORY SYSTEM PRODUCTS

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
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