CEMIPLIMAB

CEMIPLIMAB (13135H)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13135H
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Metastatic or locally advanced cutaneous squamous cell carcinoma (CSCC)
Treatment phase: Initial treatment covering the first 3 treatment cycles
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 2 DPMA: $7,528.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13152F)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13152F
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Metastatic or locally advanced cutaneous squamous cell carcinoma (CSCC)
Treatment phase: Initial treatment covering the first 3 treatment cycles
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 2 DPMA: $7,381.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13153G)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13153G
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Metastatic or locally advanced cutaneous squamous cell carcinoma (CSCC)
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 7 DPMA: $7,528.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13159N)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13159N
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Metastatic or locally advanced cutaneous squamous cell carcinoma (CSCC)
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 7 DPMA: $7,381.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13160P)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13160P
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18455)

Indication: Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Initial treatment - 3 weekly treatment regimen
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 6 DPMA: $7,528.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13161Q)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13161Q
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15063)

Indication: Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment - 3 weekly treatment regimen
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 6 DPMA: $7,381.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13162R)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13162R
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15063)

Indication: Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Continuing treatment - 3 weekly treatment regimen
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 6 DPMA: $7,528.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)

CEMIPLIMAB (13169D)

cemiplimab 350 mg/7 mL injection, 7 mL vial
13169D
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18455)

Indication: Stage IV (metastatic) non-small cell lung cancer (NSCLC)
Treatment phase: Initial treatment - 3 weekly treatment regimen
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 350 mg # of repeats: 6 DPMA: $7,381.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Libtayo
(cemiplimab 350 mg/7 mL injection, 7 mL vial)