Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13818GMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	20 mcg	0	$17964.53	$31.60	$31.60

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13819HMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	30 mcg	0	$17673.69	$31.60	$31.60

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13822LMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	68 mcg	0	$17964.53	$31.60	$31.60

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13823MMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	136 mcg	7	$35257.25	$31.60	$31.60

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13824NMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	136 mcg	7	$35794.26	$31.60	$31.60

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13831YMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	68 mcg	0	$17673.69	$31.60	$31.60

Source	Chemotherapy Items for Public Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13832BMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	20 mcg	0	$17673.69	$31.60	$31.60

Source	Chemotherapy Items for Private Hospital use - Explanatory Notes
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ANTINEOPLASTIC AGENTS > OTHER ANTINEOPLASTIC AGENTS

Caution

Note

Authority Required (STREAMLINED)

Code & Prescriber	Name, manner of administration	Max amount	No. of repeats	DPMA	Max Safety Net	General Patient Charge
13833CMP	TEBENTAFUSP Injection (PI, CMI) Available brands Kimmtrak (tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)	30 mcg	0	$17964.53	$31.60	$31.60