OFATUMUMAB

OFATUMUMAB (12641H)

ofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device
12641H
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16301)

Indication: Multiple sclerosis
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: 1 # of repeats: 5 DPMQ: $2,185.13 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kesimpta

OFATUMUMAB (12642J)

ofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device
12642J
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16323)

Indication: Multiple sclerosis
Treatment phase: Initial 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: 0 DPMQ: $6,337.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kesimpta