ADALIMUMAB

ADALIMUMAB (12422T)

adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL syringes
12422T
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

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

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing treatment, Face, hand, foot

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Balance of supply - Continuing treatment, Whole body or Continuing treatment, Face, hand, foot

Restriction

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

Restriction

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
Hadlima
Humira
Hyrimoz
Yuflyma