BUROSUMAB

BUROSUMAB (13136J)

burosumab 20 mg/mL injection, 1 mL vial
13136J
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: Initial treatment - New patient

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: 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: 5 DPMQ: $8,046.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Crysvita

BUROSUMAB (13140N)

burosumab 10 mg/mL injection, 1 mL vial
13140N
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: Initial treatment - New patient

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: 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: 5 DPMQ: $3,999.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Crysvita

BUROSUMAB (13145W)

burosumab 20 mg/mL injection, 1 mL vial
13145W
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: Initial treatment - New patient

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: 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: 5 DPMQ: $7,998.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Crysvita

BUROSUMAB (13154H)

burosumab 30 mg/mL injection, 1 mL vial
13154H
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: Initial treatment - New patient

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: 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: 5 DPMQ: $12,045.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Crysvita

BUROSUMAB (13155J)

burosumab 30 mg/mL injection, 1 mL vial
13155J
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: Initial treatment - New patient

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: 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: 5 DPMQ: $11,997.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Crysvita

BUROSUMAB (13163T)

burosumab 10 mg/mL injection, 1 mL vial
13163T
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: Initial treatment - New patient

Restriction

Indication: X-linked hypophosphataemia
Treatment phase: 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: 5 DPMQ: $4,047.88 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Crysvita