PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 10424PMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 7 | $7891.46 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 10436GMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 7 | $7738.73 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 10475HMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 5 | $7891.46 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 10493GMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 5 | $7738.73 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 11330HMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15386.23 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 11352LMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15646.02 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 11492WMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 6 | $7891.46 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 11494YMP | PEMBROLIZUMAB Injection (PI, CMI)
|
200 mg | 6 | $7738.73 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 11632FMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15646.02 | $31.60 | $31.60 |
PEMBROLIZUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | ||
|---|---|---|---|---|---|---|---|---|
| 11646YMP | PEMBROLIZUMAB Injection (PI, CMI)
|
400 mg | 6 | $15386.23 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner




