ENZALUTAMIDE

ENZALUTAMIDE (10174L)

enzalutamide 40 mg capsule, 112
10174L
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Castration resistant metastatic carcinoma of the prostate
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 112 # of repeats: 2 DPMQ: $3,313.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xtandi

ENZALUTAMIDE (13118K)

enzalutamide 40 mg capsule, 112
13118K
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Castration resistant non-metastatic carcinoma of the prostate
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 112 # of repeats: 5 DPMQ: $3,313.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xtandi

ENZALUTAMIDE (13353T)

enzalutamide 40 mg capsule, 112
13353T
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Metastatic castration sensitive carcinoma of the prostate
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 112 # of repeats: 5 DPMQ: $3,313.56 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Xtandi