TEBENTAFUSP

TEBENTAFUSP (13818G)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13818G
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Initial treatment - day 1
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 20 mcg # of repeats: 0 DPMA: $17,966.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13819H)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13819H
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14821)

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Initial treatment - day 8
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 30 mcg # of repeats: 0 DPMA: $17,674.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13822L)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13822L
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14825)

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Initial treatment - day 15
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 68 mcg # of repeats: 0 DPMA: $17,966.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13823M)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13823M
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15085)

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 136 mcg # of repeats: 7 DPMA: $35,258.35 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13824N)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13824N
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15085)

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 136 mcg # of repeats: 7 DPMA: $35,796.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13831Y)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13831Y
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14825)

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Initial treatment - day 15
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 68 mcg # of repeats: 0 DPMA: $17,674.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13832B)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13832B
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Initial treatment - day 1
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 20 mcg # of repeats: 0 DPMA: $17,674.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)

TEBENTAFUSP (13833C)

tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial
13833C
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14821)

Indication: Advanced (unresectable or metastatic) uveal melanoma
Treatment phase: Initial treatment - day 8
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 30 mcg # of repeats: 0 DPMA: $17,966.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kimmtrak
(tebentafusp 100 microgram/0.5 mL injection, 0.5 mL vial)