USTEKINUMAB
Manner of administration:Injection
Restriction
Indication: Severe psoriatic arthritis
Treatment phase: First continuing treatment
Restriction
Indication: Severe psoriatic arthritis
Treatment phase: First continuing, Subsequent continuing treatment - balance of supply
Restriction
Indication: Severe psoriatic 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: 1 | # of repeats: 1 | DPMQ: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 1 (new patient)
Restriction
Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break
in biological medicine of less than 5 years)
Restriction
Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological
medicine of more than 5 years)
Restriction
Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 1 (new patient), Initial 2 (change or recommencement of
treatment after a break in medicine of less than 5 years) or Initial 3 (recommencement
of treatment after a break in biological medicine of more than 5 years) - 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: 2 | DPMQ: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe Crohn disease
Treatment phase: Initial treatment - Initial 1 (new patient)
Restriction
Indication: Severe Crohn disease
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break
in biological medicine of less than 5 years)
Restriction
Indication: Severe Crohn disease
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological
medicine of more than 5 years)
Restriction
Indication: Severe Crohn disease
Treatment phase: First continuing treatment
Restriction
Indication: Severe Crohn disease
Treatment phase: Subsequent continuing treatment
Restriction
Indication: Severe Crohn disease
Treatment phase: Balance of supply
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 0 | DPMQ: $1,570.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing, Subsequent continuing treatment - balance of supply (Whole body,
or, face/hand/foot)
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: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing treatment (Whole body) - treatment covering week 28 and onwards
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing treatment (Face, hand, foot) - treatment covering week 28 and onwards
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment (Whole body)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment (Face, hand, foot)
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: 1 | DPMQ: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial 1 treatment (Whole body) - biological medicine-naive patient
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial 2 treatment (Whole body) - Change of treatment, or, recommencement of treatment
after a break in biological medicine of less than 5 years
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial 3 treatment (Whole body, or, face/hand/foot) - Recommencement of treatment
after a break in biological medicine of more than 5 years
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Balance of supply - Initial 1, 2 or 3 treatment (Whole body, or, face/hand/foot)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial 1 treatment (Face, hand, foot) - biological medicine-naive patient
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial 2 treatment (Face, hand, foot) - Change or recommencement of treatment after
a break in biological medicine of less than 5 years
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: 2 | DPMQ: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 1, Whole body (new patient)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 2, Whole body (change or re-commencement of treatment
after a break in biological medicine of less than 5 years)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 3, Whole body (re-commencement of treatment after a break
in biological medicine of more than 5 years)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 1, Face, hand, foot (new patient)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 2, Face, hand, foot (change or re-commencement of treatment
after a break in biological medicine of less than 5 years)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 3, Face, hand, foot (re-commencement of treatment after
a break in biological medicine of more than 5 years)
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 1, Whole body or Face, hand, foot (new patient) or Initial
2, Whole body or Face, hand, foot (change or re-commencement of treatment after a
break in biological medicine of less than 5 years) or Initial 3, Whole body or Face,
hand, foot (re-commencement of treatment after a break in biological medicine of more
than 5 years) - 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: 2 | DPMQ: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||
Manner of administration:Injection
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing treatment, Whole body
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: First continuing treatment, Face, hand, foot
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Continuing treatment, Whole body or Continuing treatment, Face, hand, foot - balance
of supply
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment, Whole body
Restriction
Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment, Face, hand, foot
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: 1 | DPMQ: $789.74 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Stelara | |||||