EVEROLIMUS

EVEROLIMUS (11258M)

everolimus 2.5 mg tablet, 30
11258M
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7431)

Indication: Tuberous sclerosis complex (TSC)
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: 30 # of repeats: 5 DPMQ: $458.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Afinitor

EVEROLIMUS (2818H)

everolimus 2.5 mg tablet, 30
2818H
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Tuberous sclerosis complex (TSC)
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: 30 # of repeats: 5 DPMQ: $458.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Afinitor