COBIMETINIB

COBIMETINIB (11074W)

cobimetinib 20 mg tablet, 63
11074W
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10033)

Indication: Unresectable Stage III or Stage IV malignant melanoma
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: 63 # of repeats: 3 DPMQ: $7,035.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Cotellic

COBIMETINIB (11075X)

cobimetinib 20 mg tablet, 63
11075X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17807)

Indication: Unresectable Stage III or Stage IV malignant melanoma
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: 63 # of repeats: 5 DPMQ: $7,035.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Cotellic