FILGRASTIM
filgrastim 480 microgram/0.5 mL injection, 5 x 0.5 mL syringes
FILGRASTIM (2733W)
2733W
Body System:
Manner of administration:Injection
Restriction 8674
Indication: Chemotherapy-induced neutropenia
Restriction 8667
Indication: Chemotherapy-induced neutropenia
Restriction 8672
Indication: Mobilisation of peripheral blood progenitor cells
Restriction 8668
Indication: Mobilisation of peripheral blood progenitor cells
Restriction 8671
Indication: Assisting bone marrow transplantation
Restriction 8696
Indication: Assisting autologous peripheral blood progenitor cell transplantation
Restriction 8669
Indication: Severe congenital neutropenia
Restriction 8670
Indication: Severe chronic neutropenia
Restriction 8673
Indication: Chronic cyclical neutropenia
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 20 | # of repeats: 11 | DPMQ: $400.56 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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