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
10170GMP	IVACAFTOR ivacaftor 150 mg tablet, 56 (PI, CMI)	1	56	5	$21375.00	$31.60	$31.60
	Available brands
	Kalydeco

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
10175MMP	IVACAFTOR ivacaftor 150 mg tablet, 56 (PI, CMI)	1	56	5	$21423.67	$31.60	$31.60
	Available brands
	Kalydeco

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
14153XMP	IVACAFTOR ivacaftor 150 mg tablet, 56 (PI, CMI)	1	56	5	$21375.00	$31.60	$31.60
	Available brands
	Kalydeco

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
14169RMP	IVACAFTOR ivacaftor 150 mg tablet, 56 (PI, CMI)	1	56	5	$21423.67	$31.60	$31.60
	Available brands
	Kalydeco