ADALIMUMAB

ADALIMUMAB (13211H)

adalimumab 40 mg/0.4 mL injection, 2 x 0.4 mL pen devices
13211H
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16991)

Indication: Moderate to severe ulcerative colitis
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
Hadlima
Humira
Hyrimoz
Yuflyma