EVEROLIMUS

EVEROLIMUS (11599L)

everolimus 3 mg dispersible tablet, 30
11599L
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Refractory seizures associated with tuberous sclerosis complex
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: $548.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Afinitor

EVEROLIMUS (11608Y)

everolimus 3 mg dispersible tablet, 30
11608Y
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17539)

Indication: Refractory seizures associated with tuberous sclerosis complex
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: $548.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Afinitor