DIFELIKEFALIN

difelikefalin 50 microgram/mL injection, 12 x 1 mL vials
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: Moderate to severe pruritus (itching) associated with chronic kidney disease
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: 12 # of repeats: 5 DPMQ: $570.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Korsuva
difelikefalin 50 microgram/mL injection, 12 x 1 mL vials
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: Moderate to severe pruritus (itching) associated with chronic kidney disease
Treatment phase: Initial 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: 12 # of repeats: 2 DPMQ: $570.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Korsuva
difelikefalin 50 microgram/mL injection, 12 x 1 mL vials
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: Moderate to severe pruritus (itching) associated with chronic kidney disease
Treatment phase: Initial 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: 12 # of repeats: 2 DPMQ: $540.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Korsuva
difelikefalin 50 microgram/mL injection, 12 x 1 mL vials
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: Moderate to severe pruritus (itching) associated with chronic kidney disease
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: 12 # of repeats: 5 DPMQ: $540.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Korsuva