RISDIPLAM

risdiplam 5 mg tablet, 28

RISDIPLAM (15290R)

risdiplam 5 mg tablet, 28
15290R
Manner of administration:Oral
Private
S100 HSD Private
Authority Required

Restriction

Indication: Spinal muscular atrophy (SMA)
Treatment phase: Continuing/maintenance treatment in an adult where treatment was initiated in adulthood
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $25,346.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Evrysdi