INFLIXIMAB

INFLIXIMAB (11605T)

infliximab 100 mg injection, 1 vial
11605T
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8844)

Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment, Whole body

Restriction (Streamlined authority code: 8940)

Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment, Face, hand, foot
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 5 Max qty units: 5 # of repeats: 2 DPMQ: $930.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Inflectra
Ixifi
Remsima
Renflexis