ADALIMUMAB

ADALIMUMAB (12401Q)

adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices
12401Q
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 11604)

Indication: Severe active juvenile idiopathic 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: 1 Max qty units: 2 # of repeats: 5 DPMQ: $494.12 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Abrilada
Amgevita
Hadlima
Hyrimoz