EVEROLIMUS

EVEROLIMUS (14040Y)

everolimus 750 microgram tablet, 60
14040Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 240 # of repeats: 3 DPMQ: $1,752.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Certican
Everocan

EVEROLIMUS (5740D)

everolimus 750 microgram tablet, 60
5740D
Body System:
Manner of administration:Oral
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19365)

Indication: Management of renal allograft rejection
Treatment phase: Management (initiation, stabilisation and review of therapy)

Restriction (Streamlined authority code: 19366)

Indication: Management of cardiac allograft rejection
Treatment phase: Management (initiation, stabilisation and review of therapy)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 240 # of repeats: 5 DPMQ: $1,591.24 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Certican
Everocan

EVEROLIMUS (6461C)

everolimus 750 microgram tablet, 60
6461C
Body System:
Manner of administration:Oral
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 19370)

Indication: Management of renal allograft rejection
Treatment phase: Management (initiation, stabilisation and review of therapy)

Restriction (Streamlined authority code: 19459)

Indication: Management of cardiac allograft rejection
Treatment phase: Management (initiation, stabilisation and review of therapy)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 240 # of repeats: 5 DPMQ: $1,640.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Certican
Everocan

EVEROLIMUS (8842J)

everolimus 750 microgram tablet, 60
8842J
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 3 DPMQ: $880.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Certican
Everocan