EVOLOCUMAB

EVOLOCUMAB (10958R)

evolocumab 140 mg/mL injection, 1 mL pen device
10958R
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17313)

Indication: Familial homozygous hypercholesterolaemia
Treatment phase: Initial treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $652.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Repatha

EVOLOCUMAB (11484K)

evolocumab 140 mg/mL injection, 1 mL pen device
11484K
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16294)

Indication: Familial heterozygous hypercholesterolaemia
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 16351)

Indication: Non-familial hypercholesterolaemia
Treatment phase: Initial 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: $437.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Repatha

EVOLOCUMAB (11977J)

evolocumab 140 mg/mL injection, 1 mL pen device
11977J
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17402)

Indication: Familial homozygous hypercholesterolaemia
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $652.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Repatha

EVOLOCUMAB (11985T)

evolocumab 140 mg/mL injection, 1 mL pen device
11985T
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16336)

Indication: Non-familial hypercholesterolaemia
Treatment phase: Continuing treatment with this drug or switching treatment from any of: (i) another drug that belongs to the same pharmacological class as this drug, (ii) inclisiran

Restriction (Streamlined authority code: 16350)

Indication: Familial heterozygous hypercholesterolaemia
Treatment phase: Continuing treatment with this drug or switching treatment from any of: (i) another drug that belongs to the same pharmacological class as this drug, (ii) inclisiran
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: $437.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Repatha