ADALIMUMAB

ADALIMUMAB (12403T)

adalimumab 40 mg/0.8 mL injection, 2 x 0.8 mL pen devices
12403T
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 11635)

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

Restriction (Streamlined authority code: 11606)

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: 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