IDELALISIB

IDELALISIB (11162L)

idelalisib 150 mg tablet, 60
11162L
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL)
Treatment phase: Initial treatment

Restriction

Indication: Chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL)
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: 60 # of repeats: 5 DPMQ: $5,119.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zydelig

IDELALISIB (11165P)

idelalisib 150 mg tablet, 60
11165P
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Refractory follicular B-cell non-Hodgkin's lymphoma
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: 60 # of repeats: 5 DPMQ: $5,119.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zydelig

IDELALISIB (12812H)

idelalisib 150 mg tablet, 60
12812H
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17893)

Indication: Refractory follicular B-cell non-Hodgkin's lymphoma
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: 60 # of repeats: 5 DPMQ: $5,119.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Zydelig