ETANERCEPT

etanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack

ETANERCEPT (13693Q)

etanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack
13693Q
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14509)

Indication: Severe chronic plaque psoriasis
Treatment phase: Completion of course - treatment covering weeks 16 to 24 (Whole body)

Restriction (Streamlined authority code: 14508)

Indication: Severe chronic plaque psoriasis
Treatment phase: Completion of course - treatment covering weeks 16 to 24 (Face, hand, foot)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 1 DPMQ: $846.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Enbrel