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

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
6363XMP	PEGFILGRASTIM pegfilgrastim 6 mg/0.6 mL injection, 0.6 mL syringe (PI, CMI)	1	1	11	$104.30	$31.60	$31.60
	Available brands
	Pelgraza
	Ziextenzoa

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

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
9514RMP	PEGFILGRASTIM pegfilgrastim 6 mg/0.6 mL injection, 0.6 mL syringe (PI, CMI)	1	1	11	$91.63	$31.60	$31.60
	Available brands
	Pelgraza
	Ziextenzoa