PEMBROLIZUMAB

PEMBROLIZUMAB (13114F)

pembrolizumab 100 mg/4 mL injection, 4 mL vial
13114F
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18452)

Indication: Recurrent or metastatic squamous cell carcinoma of the oral cavity, pharynx or larynx
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 13731)

Indication: Recurrent or metastatic squamous cell carcinoma of the oral cavity, pharynx or larynx
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 400 mg # of repeats: 6 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)