Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
13175KMP	PEGCETACOPLAN pegcetacoplan 1.08 g/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$4343.86	$31.60	$31.60
	Available brands
	Empaveli

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
13180QMP	PEGCETACOPLAN pegcetacoplan 1.08 g/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$4343.86	$31.60	$31.60
	Available brands
	Empaveli

Source	S100 HSD Public
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
13185YMP	PEGCETACOPLAN pegcetacoplan 1.08 g/20 mL injection, 20 mL vial (PI, CMI)	1	1	5	$4343.86	$31.60	$31.60
	Available brands
	Empaveli

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
13191GMP	PEGCETACOPLAN pegcetacoplan 1.08 g/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$4392.53	$31.60	$31.60
	Available brands
	Empaveli

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
13196MMP	PEGCETACOPLAN pegcetacoplan 1.08 g/20 mL injection, 20 mL vial (PI, CMI)	1	1	0	$4392.53	$31.60	$31.60
	Available brands
	Empaveli

Source	S100 HSD Private
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > IMMUNOSUPPRESSANTS > IMMUNOSUPPRESSANTS

Caution

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
13197NMP	PEGCETACOPLAN pegcetacoplan 1.08 g/20 mL injection, 20 mL vial (PI, CMI)	1	1	5	$4392.53	$31.60	$31.60
	Available brands
	Empaveli