SACITUZUMAB GOVITECAN

SACITUZUMAB GOVITECAN (12944G)

sacituzumab govitecan 180 mg injection, 1 vial
12944G
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 12656)

Indication: Unresectable locally advanced or metastatic triple-negative breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 7 DPMA: $10,674.49 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Trodelvy
(sacituzumab govitecan 180 mg injection, 1 vial)

SACITUZUMAB GOVITECAN (12945H)

sacituzumab govitecan 180 mg injection, 1 vial
12945H
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 12669)

Indication: Unresectable locally advanced or metastatic triple-negative breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 13 DPMA: $10,483.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Trodelvy
(sacituzumab govitecan 180 mg injection, 1 vial)

SACITUZUMAB GOVITECAN (12965J)

sacituzumab govitecan 180 mg injection, 1 vial
12965J
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 12669)

Indication: Unresectable locally advanced or metastatic triple-negative breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 13 DPMA: $10,674.49 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Trodelvy
(sacituzumab govitecan 180 mg injection, 1 vial)

SACITUZUMAB GOVITECAN (12966K)

sacituzumab govitecan 180 mg injection, 1 vial
12966K
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 12656)

Indication: Unresectable locally advanced or metastatic triple-negative breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 7 DPMA: $10,483.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Trodelvy
(sacituzumab govitecan 180 mg injection, 1 vial)