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
5794YMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 30 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$221.00	$31.60	$31.60
	Available brands
	Mircera

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
5795BMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 50 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$368.34	$31.60	$31.60
	Available brands
	Mircera

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
5796CMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 75 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$536.36	$31.60	$31.60
	Available brands
	Mircera

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
5797DMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 100 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$693.68	$31.60	$31.60
	Available brands
	Mircera

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
5798EMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 120 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$803.12	$31.60	$31.60
	Available brands
	Mircera

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
5799FMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 200 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$1151.90	$31.60	$31.60
	Available brands
	Mircera

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
5800GMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 360 microgram/0.6 mL injection, 0.6 mL syringe (PI, CMI)	2	2	5	$1991.30	$31.60	$31.60
	Available brands
	Mircera

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
9574XMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 30 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$238.51	$31.60	$31.60
	Available brands
	Mircera

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
9575YMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 50 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$391.75	$31.60	$31.60
	Available brands
	Mircera

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
9576BMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 75 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$566.49	$31.60	$31.60
	Available brands
	Mircera

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
9577CMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 100 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$730.09	$31.60	$31.60
	Available brands
	Mircera

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
9578DMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 120 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$843.91	$31.60	$31.60
	Available brands
	Mircera

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
9579EMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 200 microgram/0.3 mL injection, 0.3 mL syringe (PI, CMI)	2	2	5	$1200.57	$31.60	$31.60
	Available brands
	Mircera

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
9580FMP	METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA methoxy polyethylene glycol-epoetin beta 360 microgram/0.6 mL injection, 0.6 mL syringe (PI, CMI)	2	2	5	$2039.97	$31.60	$31.60
	Available brands
	Mircera