OLAPARIB

OLAPARIB (11528R)

olaparib 150 mg tablet, 56
11528R
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 (11539H)

olaparib 150 mg tablet, 56
11539H
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 (12157W)

olaparib 150 mg tablet, 56
12157W
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 (12161C)

olaparib 150 mg tablet, 56
12161C
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 (12913P)

olaparib 150 mg tablet, 56
12913P
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 (12929L)

olaparib 150 mg tablet, 56
12929L
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 (13800H)

olaparib 150 mg tablet, 56
13800H
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 (13807Q)

olaparib 150 mg tablet, 56
13807Q
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 (14208T)

olaparib 150 mg tablet, 56
14208T
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 (14215E)

olaparib 150 mg tablet, 56
14215E
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