ABATACEPT

ABATACEPT (11684Y)

abatacept 125 mg/mL injection, 4 x 1 mL pen devices
11684Y
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 4 # of repeats: 5 DPMQ: $947.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia ClickJect

ABATACEPT (11693K)

abatacept 125 mg/mL injection, 4 x 1 mL pen devices
11693K
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 1 (new patient)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 24 months)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological medicine of more than 24 months)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Balance of supply - Initial 1 (new patient) or Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 24 months) or Initial 3 (recommencement of treatment after a break in biological medicine of more than 24 months)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 4 # of repeats: 3 DPMQ: $947.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia ClickJect

ABATACEPT (1220F)

abatacept 125 mg/mL injection, 4 x 1 mL syringes
1220F
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 1 (new patient)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 24 months)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological medicine of more than 24 months)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Balance of supply - Initial 1 (new patient) or Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 24 months) or Initial 3 (recommencement of treatment after a break in biological medicine of more than 24 months)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 4 # of repeats: 3 DPMQ: $947.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia

ABATACEPT (1221G)

abatacept 125 mg/mL injection, 4 x 1 mL syringes
1221G
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 4 # of repeats: 5 DPMQ: $947.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia

ABATACEPT (13705H)

abatacept 250 mg injection, 1 vial
13705H
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14555)

Indication: Severe active rheumatoid arthritis
Treatment phase: Subsequent 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: $827.58 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia

ABATACEPT (13725J)

abatacept 250 mg injection, 1 vial
13725J
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14604)

Indication: Severe active rheumatoid arthritis
Treatment phase: Subsequent 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: $787.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia

ABATACEPT (13726K)

abatacept 125 mg/mL injection, 4 x 1 mL syringes
13726K
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14604)

Indication: Severe active rheumatoid arthritis
Treatment phase: Subsequent 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: 4 # of repeats: 5 DPMQ: $947.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia

ABATACEPT (13727L)

abatacept 125 mg/mL injection, 4 x 1 mL pen devices
13727L
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14604)

Indication: Severe active rheumatoid arthritis
Treatment phase: Subsequent 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: 4 # of repeats: 5 DPMQ: $947.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia ClickJect

ABATACEPT (5605B)

abatacept 250 mg injection, 1 vial
5605B
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 1 (new patient)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 24 months)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological medicine of more than 24 months)

Restriction

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $262.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia

ABATACEPT (9621J)

abatacept 250 mg injection, 1 vial
9621J
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 1 (new patient)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 24 months)

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological medicine of more than 24 months)

Restriction

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: First continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $281.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Orencia