PERTUZUMAB

PERTUZUMAB (10267J)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10267J
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 840 mg # of repeats: 0 DPMA: $5,636.85 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (10308M)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10308M
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 420 mg # of repeats: 3 DPMA: $2,948.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (10333W)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10333W
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 420 mg # of repeats: 3 DPMA: $2,864.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (10334X)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10334X
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 840 mg # of repeats: 0 DPMA: $5,760.16 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)