INFLIXIMAB

INFLIXIMAB (11490R)

infliximab 100 mg injection, 1 vial
11490R
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14504)

Indication: Severe active rheumatoid arthritis
Treatment phase: Subsequent continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 2 DPMQ: $558.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Inflectra
Ixifi
Remicade
Remsima
Renflexis