LIPEGFILGRASTIM

LIPEGFILGRASTIM (10931H)

lipegfilgrastim 6 mg/0.6 mL injection, 0.6 mL syringe
10931H
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 9224)

Indication: Chemotherapy-induced neutropenia

Restriction (Streamlined authority code: 9322)

Indication: Chemotherapy-induced neutropenia
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: 11 DPMQ: $1,165.13 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lonquex

LIPEGFILGRASTIM (10936N)

lipegfilgrastim 6 mg/0.6 mL injection, 0.6 mL syringe
10936N
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7822)

Indication: Chemotherapy-induced neutropenia

Restriction (Streamlined authority code: 7843)

Indication: Chemotherapy-induced neutropenia
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: 11 DPMQ: $1,116.25 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lonquex