PASIREOTIDE EMBONATE

PASIREOTIDE EMBONATE (10883T)

pasireotide (as embonate) 40 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
10883T
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: Acromegaly
Treatment phase: Initial treatment

Restriction

Indication: Acromegaly
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $7,410.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Signifor LAR

PASIREOTIDE EMBONATE (10884W)

pasireotide (as embonate) 40 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack
10884W
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: Acromegaly
Treatment phase: Initial treatment

Restriction

Indication: Acromegaly
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $7,458.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Signifor LAR