PEMBROLIZUMAB

PEMBROLIZUMAB (12121Y)

pembrolizumab 100 mg/4 mL injection, 4 mL vial
12121Y
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18453)

Indication: Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Initial treatment - 6 weekly treatment regimen

Restriction (Streamlined authority code: 13437)

Indication: Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment - 6 weekly treatment regimen
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 400 mg # of repeats: 3 DPMA: $14,870.58 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Keytruda
(pembrolizumab 100 mg/4 mL injection, 4 mL vial)