SAPROPTERIN
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia
Treatment phase: Initial treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 0 | DPMQ: $4,819.80 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 5 | DPMQ: $4,819.80 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Initial treatment - responsiveness testing
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: 0 | DPMQ: $833.22 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: First continuing treatment
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Subsequent continuing
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 5 | DPMQ: $4,819.80 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to tetrahydrobiopterin (BH4) deficiency
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: $4,043.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Initial treatment - responsiveness testing
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: 0 | DPMQ: $4,043.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to tetrahydrobiopterin (BH4) deficiency
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: 0 | DPMQ: $4,043.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: First continuing treatment
Restriction
Indication: Hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Subsequent continuing
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: $4,043.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Maternal hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Pre-conception through to when pregnancy first becomes known
Restriction
Indication: Maternal hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Existing pregnancy to birth
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: $833.22 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||
Manner of administration:Oral
Restriction
Indication: Maternal hyperphenylalaninaemia (HPA) due to phenylketonuria (PKU)
Treatment phase: Initial treatment - responsiveness testing
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: 0 | DPMQ: $4,043.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Kuvan | |||||