OLAPARIB

OLAPARIB (11503K)

olaparib 100 mg tablet, 56
11503K
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17910)

Indication: High grade epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Continuation of subsequent-line maintenance therapy (BRCA1/2 gene mutation)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (11522K)

olaparib 100 mg tablet, 56
11522K
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: High grade epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Initial subsequent-line maintenance therapy (BRCA1/2 gene mutation)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 2 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (12169L)

olaparib 100 mg tablet, 56
12169L
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Continuation of first-line maintenance therapy (BRCA1/2 gene mutation)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (12170M)

olaparib 100 mg tablet, 56
12170M
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Initial first-line maintenance therapy (BRCA1/2 gene mutation)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 2 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (12921C)

olaparib 100 mg tablet, 56
12921C
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Castration resistant metastatic carcinoma of the prostate
Treatment phase: Continuing 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: 112 # of repeats: 5 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (12932P)

olaparib 100 mg tablet, 56
12932P
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Castration resistant metastatic carcinoma of the prostate
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: 112 # of repeats: 2 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (13782J)

olaparib 100 mg tablet, 56
13782J
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Continuation of first-line maintenance therapy (genomic instability without BRCA1/2 gene mutation)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (13783K)

olaparib 100 mg tablet, 56
13783K
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Initial first-line maintenance therapy (genomic instability without BRCA1/2 gene mutation)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 2 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (14181J)

olaparib 100 mg tablet, 56
14181J
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Early breast cancer
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: 112 # of repeats: 5 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza

OLAPARIB (14216F)

olaparib 100 mg tablet, 56
14216F
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Early breast cancer
Treatment phase: Continuing 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: 112 # of repeats: 6 DPMQ: $6,632.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lynparza