Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5713QMP	EPOETIN ALFA epoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$2442.22	$31.60	$31.60
	Available brands
	Eprex 20,000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5714RMP	EPOETIN ALFA epoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$175.98	$31.60	$31.60
	Available brands
	Eprex 1000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5715TMP	EPOETIN ALFA epoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$666.22	$31.60	$31.60
	Available brands
	Eprex 5000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5716WMP	EPOETIN ALFA epoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes (PI, CMI)	2	12	5	$790.84	$31.60	$31.60
	Available brands
	Eprex 6000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5717XMP	EPOETIN ALFA epoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes (PI, CMI)	2	12	5	$1025.72	$31.60	$31.60
	Available brands
	Eprex 8000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5718YMP	EPOETIN ALFA epoetin alfa 40 000 units/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$790.12	$31.60	$31.60
	Available brands
	Eprex 40,000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5719BMP	EPOETIN ALFA epoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$325.64	$31.60	$31.60
	Available brands
	Eprex 2000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5720CMP	EPOETIN ALFA epoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes (PI, CMI)	2	12	5	$420.20	$31.60	$31.60
	Available brands
	Eprex 3000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5721DMP	EPOETIN ALFA epoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes (PI, CMI)	2	12	5	$535.14	$31.60	$31.60
	Available brands
	Eprex 4000

Source	S100 HSD Public
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
5722EMP	EPOETIN ALFA epoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes (PI, CMI)	2	12	5	$1241.44	$31.60	$31.60
	Available brands
	Eprex 10000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6204MMP	EPOETIN ALFA epoetin alfa 2000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$347.33	$31.60	$31.60
	Available brands
	Eprex 2000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6205NMP	EPOETIN ALFA epoetin alfa 3000 units/0.3 mL injection, 6 x 0.3 mL syringes (PI, CMI)	2	12	5	$445.67	$31.60	$31.60
	Available brands
	Eprex 3000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6206PMP	EPOETIN ALFA epoetin alfa 4000 units/0.4 mL injection, 6 x 0.4 mL syringes (PI, CMI)	2	12	5	$565.21	$31.60	$31.60
	Available brands
	Eprex 4000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6207QMP	EPOETIN ALFA epoetin alfa 10 000 units/mL injection, 6 x 1 mL syringes (PI, CMI)	2	12	5	$1290.11	$31.60	$31.60
	Available brands
	Eprex 10000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6251BMP	EPOETIN ALFA epoetin alfa 1000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$191.69	$31.60	$31.60
	Available brands
	Eprex 1000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6302QMP	EPOETIN ALFA epoetin alfa 5000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$701.53	$31.60	$31.60
	Available brands
	Eprex 5000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6303RMP	EPOETIN ALFA epoetin alfa 6000 units/0.6 mL injection, 6 x 0.6 mL syringes (PI, CMI)	2	12	5	$831.15	$31.60	$31.60
	Available brands
	Eprex 6000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6305WMP	EPOETIN ALFA epoetin alfa 8000 units/0.8 mL injection, 6 x 0.8 mL syringes (PI, CMI)	2	12	5	$1074.39	$31.60	$31.60
	Available brands
	Eprex 8000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6339PMP	EPOETIN ALFA epoetin alfa 40 000 units/mL injection, 1 mL syringe (PI, CMI)	2	2	5	$830.39	$31.60	$31.60
	Available brands
	Eprex 40,000

Source	S100 HSD Private
Body System	BLOOD AND BLOOD FORMING ORGANS > ANTIANEMIC PREPARATIONS > OTHER ANTIANEMIC PREPARATIONS

Authority Required (STREAMLINED)

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
6434PMP	EPOETIN ALFA epoetin alfa 20 000 units/0.5 mL injection, 6 x 0.5 mL syringes (PI, CMI)	2	12	5	$2490.89	$31.60	$31.60
	Available brands
	Eprex 20,000