ETANERCEPT

etanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack

ETANERCEPT (9429G)

etanercept 25 mg injection [4 vials] (&) inert substance diluent [4 x 1 mL syringes], 1 pack
9429G
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

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

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing treatment, Face, hand, foot

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Continuing treatment, Whole body or Continuing treatment, Face, hand, foot - balance of supply

Restriction

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

Restriction

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: 2 Max qty units: 2 # of repeats: 5 DPMQ: $846.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Enbrel