DOSTARLIMAB

DOSTARLIMAB (14109N)

dostarlimab 500 mg/10 mL injection, 10 mL vial
14109N
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15205)

Indication: Advanced, metastatic or recurrent endometrial carcinoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1000 mg # of repeats: 3 DPMA: $15,646.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Jemperli
(dostarlimab 500 mg/10 mL injection, 10 mL vial)

DOSTARLIMAB (14122G)

dostarlimab 500 mg/10 mL injection, 10 mL vial
14122G
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15163)

Indication: Advanced, metastatic or recurrent endometrial carcinoma
Treatment phase: Initial treatment covering the first 6 treatment cycles
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 500 mg # of repeats: 5 DPMA: $7,738.73 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Jemperli
(dostarlimab 500 mg/10 mL injection, 10 mL vial)

DOSTARLIMAB (14130Q)

dostarlimab 500 mg/10 mL injection, 10 mL vial
14130Q
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15205)

Indication: Advanced, metastatic or recurrent endometrial carcinoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 1000 mg # of repeats: 3 DPMA: $15,386.23 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Jemperli
(dostarlimab 500 mg/10 mL injection, 10 mL vial)

DOSTARLIMAB (14133W)

dostarlimab 500 mg/10 mL injection, 10 mL vial
14133W
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15163)

Indication: Advanced, metastatic or recurrent endometrial carcinoma
Treatment phase: Initial treatment covering the first 6 treatment cycles
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 500 mg # of repeats: 5 DPMA: $7,891.47 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Jemperli
(dostarlimab 500 mg/10 mL injection, 10 mL vial)