SILTUXIMAB

SILTUXIMAB (12922D)

siltuximab 400 mg injection, 1 vial
12922D
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: Idiopathic multicentric Castleman disease (iMCD)
Treatment phase: Initial treatment

Restriction

Indication: Idiopathic multicentric Castleman disease (iMCD)
Treatment phase: Continuing treatment
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: 4 DPMQ: $6,234.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sylvant

SILTUXIMAB (12934R)

siltuximab 400 mg injection, 1 vial
12934R
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: Idiopathic multicentric Castleman disease (iMCD)
Treatment phase: Initial treatment

Restriction

Indication: Idiopathic multicentric Castleman disease (iMCD)
Treatment phase: Continuing treatment
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: 4 DPMQ: $6,283.08 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Sylvant