UPADACITINIB
Manner of administration:Oral
Restriction
Indication: Chronic severe atopic dermatitis
Treatment phase: Dose change (increasing up to the 30 mg dose, or, decreasing back down to the 15 mg
dose) - whole body, or, face/hands
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 3 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||
Manner of administration:Oral
Restriction
Indication: Chronic severe atopic dermatitis
Treatment phase: Continuing or resuming treatment with this drug of the whole body
Restriction
Indication: Chronic severe atopic dermatitis
Treatment phase: Continuing or resuming treatment with this drug of the face and/or hands
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||
Manner of administration:Oral
Restriction
Indication: Chronic severe atopic dermatitis
Treatment phase: Initial treatment with this drug of the whole body
Restriction
Indication: Chronic severe atopic dermatitis
Treatment phase: Initial treatment with this drug of the face and/or hands
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 4 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||
Manner of administration:Oral
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Continuing treatment
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Continuing treatment - balance of supply
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||
Manner of administration:Oral
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Dose modification
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 1 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||
Manner of administration:Oral
Restriction
Indication: Severe Crohn disease
Treatment phase: Continuing (maintenance) treatment
Restriction
Indication: Severe Crohn disease
Treatment phase: Balance of supply for the Continuing (maintenance) treatment phase
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||
Manner of administration:Oral
Restriction
Indication: Severe Crohn disease
Treatment phase: Extended induction period (optional) from weeks 12 to 24
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 2 | DPMQ: $1,977.47 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Rinvoq | |||||