AVELUMAB

AVELUMAB (11671G)

avelumab 200 mg/10 mL injection, 10 mL vial
11671G
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16085)

Indication: Stage IV (metastatic) Merkel Cell Carcinoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 11 DPMA: $7,828.17 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (11679Q)

avelumab 200 mg/10 mL injection, 10 mL vial
11679Q
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16053)

Indication: Stage IV (metastatic) Merkel Cell Carcinoma
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 8 DPMA: $7,982.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (11685B)

avelumab 200 mg/10 mL injection, 10 mL vial
11685B
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16085)

Indication: Stage IV (metastatic) Merkel Cell Carcinoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 11 DPMA: $7,982.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (11695M)

avelumab 200 mg/10 mL injection, 10 mL vial
11695M
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16053)

Indication: Stage IV (metastatic) Merkel Cell Carcinoma
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1200 mg # of repeats: 8 DPMA: $7,828.17 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (13122P)

avelumab 200 mg/10 mL injection, 10 mL vial
13122P
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15485)

Indication: Locally advanced (Stage III) or metastatic (Stage IV) urothelial cancer
Treatment phase: Maintenance therapy - Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 800 mg # of repeats: 7 DPMA: $5,249.19 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (13123Q)

avelumab 200 mg/10 mL injection, 10 mL vial
13123Q
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15485)

Indication: Locally advanced (Stage III) or metastatic (Stage IV) urothelial cancer
Treatment phase: Maintenance therapy - Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 800 mg # of repeats: 7 DPMA: $5,367.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (13126W)

avelumab 200 mg/10 mL injection, 10 mL vial
13126W
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13290)

Indication: Locally advanced (Stage III) or metastatic (Stage IV) urothelial cancer
Treatment phase: Maintenance therapy - Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 800 mg # of repeats: 11 DPMA: $5,249.19 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)

AVELUMAB (13132E)

avelumab 200 mg/10 mL injection, 10 mL vial
13132E
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 13290)

Indication: Locally advanced (Stage III) or metastatic (Stage IV) urothelial cancer
Treatment phase: Maintenance therapy - Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 800 mg # of repeats: 11 DPMA: $5,367.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bavencio
(avelumab 200 mg/10 mL injection, 10 mL vial)