TRASTUZUMAB

TRASTUZUMAB (10682F)

trastuzumab 600 mg/5 mL injection, 5 mL vial
10682F
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10212)

Indication: Early HER2 positive breast cancer
Treatment phase: 3 weekly treatment regimen
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 3 DPMQ: $1,609.37 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Herceptin SC

TRASTUZUMAB (10743K)

trastuzumab 600 mg/5 mL injection, 5 mL vial
10743K
Body System:
Manner of administration:Injection
Section 100 (CT)
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10212)

Indication: Early HER2 positive breast cancer
Treatment phase: 3 weekly treatment regimen
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 3 DPMQ: $1,470.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Herceptin SC

TRASTUZUMAB (10798H)

trastuzumab 600 mg/5 mL injection, 5 mL vial
10798H
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9353)

Indication: Metastatic (Stage IV) HER2 positive breast cancer
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: 1 # of repeats: 0 DPMQ: $1,609.37 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Herceptin SC

TRASTUZUMAB (10803N)

trastuzumab 600 mg/5 mL injection, 5 mL vial
10803N
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9462)

Indication: Metastatic (Stage IV) HER2 positive breast cancer
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: 1 # of repeats: 3 DPMQ: $1,609.37 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Herceptin SC

TRASTUZUMAB (10811B)

trastuzumab 600 mg/5 mL injection, 5 mL vial
10811B
Body System:
Manner of administration:Injection
Section 100 (CT)
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9353)

Indication: Metastatic (Stage IV) HER2 positive breast cancer
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: 1 # of repeats: 0 DPMQ: $1,470.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Herceptin SC

TRASTUZUMAB (10817H)

trastuzumab 600 mg/5 mL injection, 5 mL vial
10817H
Body System:
Manner of administration:Injection
Section 100 (CT)
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9462)

Indication: Metastatic (Stage IV) HER2 positive breast cancer
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: 1 # of repeats: 3 DPMQ: $1,470.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Herceptin SC