OSIMERTINIB

OSIMERTINIB (11620N)

osimertinib 40 mg tablet, 30
11620N
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Stage IIIB (locally advanced) or Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment of second-line EGFR tyrosine kinase inhibitor therapy
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: $7,582.43 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tagrisso

OSIMERTINIB (12233W)

osimertinib 40 mg tablet, 30
12233W
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Stage IIIB (locally advanced) or Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment of first-line EGFR tyrosine kinase inhibitor therapy
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: $7,582.43 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tagrisso

OSIMERTINIB (14162J)

osimertinib 40 mg tablet, 30
14162J
Body System:
Manner of administration:Oral
General Schedule
Authority Required

Restriction

Indication: Stage IB, II or IIIA non-small cell lung cancer
Treatment phase: Adjuvant therapy
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: $7,582.43 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Tagrisso