ADALIMUMAB

ADALIMUMAB (12419P)

adalimumab 80 mg/0.8 mL injection, 0.8 mL pen device
12419P
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe Crohn disease
Treatment phase: Initial 1 (new patient)

Restriction

Indication: Severe Crohn disease
Treatment phase: Initial 2 (change or recommencement of treatment after a break in targeted therapy of less than 12 months)

Restriction

Indication: Severe Crohn disease
Treatment phase: Initial 3 (recommencement of treatment after a break in targeted therapy of more than 12 months)
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: 0 DPMQ: $2,042.73 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Humira
Hyrimoz
Yuflyma