ADALIMUMAB

adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes

ADALIMUMAB (15039M)

adalimumab 20 mg/0.2 mL injection, 2 x 0.2 mL syringes
15039M
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17065)

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

Restriction (Streamlined authority code: 16999)

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: $649.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Humira