ERLOTINIB

ERLOTINIB (10014C)

erlotinib 150 mg tablet, 30
10014C
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Stage IIIB (locally advanced) or Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 3 DPMQ: $538.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ERLOTINIB ARX
Erlotinib Sandoz

ERLOTINIB (10025P)

erlotinib 150 mg tablet, 30
10025P
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4600)

Indication: Stage IIIB (locally advanced) or Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 3 DPMQ: $538.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ERLOTINIB ARX
Erlotinib Sandoz

ERLOTINIB (11259N)

erlotinib 150 mg tablet, 30
11259N
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7446)

Indication: Stage IIIB (locally advanced) or Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 30 # of repeats: 3 DPMQ: $538.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ERLOTINIB ARX
Erlotinib Sandoz