PANITUMUMAB

PANITUMUMAB (10069Y)

10069Y
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 12066)

Indication: Metastatic colorectal cancer
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 12035)

Indication: Metastatic colorectal cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 720 mg # of repeats: 5 DPMA: $3,790.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vectibix
(panitumumab 100 mg/5 mL injection, 5 mL vial)
Vectibix
(panitumumab 400 mg/20 mL injection, 20 mL vial)

PANITUMUMAB (10082P)

10082P
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 12066)

Indication: Metastatic colorectal cancer
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 12035)

Indication: Metastatic colorectal cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 720 mg # of repeats: 5 DPMA: $3,694.57 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vectibix
(panitumumab 100 mg/5 mL injection, 5 mL vial)
Vectibix
(panitumumab 400 mg/20 mL injection, 20 mL vial)

PANITUMUMAB (10508C)

10508C
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5526)

Indication: Metastatic colorectal cancer
Treatment phase: Initial Treatment

Restriction (Streamlined authority code: 5452)

Indication: Metastatic colorectal cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 720 mg # of repeats: 9 DPMA: $3,790.68 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vectibix
(panitumumab 100 mg/5 mL injection, 5 mL vial)
Vectibix
(panitumumab 400 mg/20 mL injection, 20 mL vial)

PANITUMUMAB (10513H)

10513H
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 5526)

Indication: Metastatic colorectal cancer
Treatment phase: Initial Treatment

Restriction (Streamlined authority code: 5452)

Indication: Metastatic colorectal cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 720 mg # of repeats: 9 DPMA: $3,694.57 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Vectibix
(panitumumab 100 mg/5 mL injection, 5 mL vial)
Vectibix
(panitumumab 400 mg/20 mL injection, 20 mL vial)