NIRAPARIB
Manner of administration:Oral
Restriction
Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Continuation of first-line maintenance therapy (genomic instability without BRCA1/2
gene mutation) in a patient requiring a daily dose of 3 tablets
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 84 | # of repeats: 5 | DPMQ: $9,875.19 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Zejula | |||||
Manner of administration:Oral
Restriction
Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Continuation of first-line maintenance therapy (BRCA1/2 gene mutation) in a patient
requiring a daily dose of 3 tablets
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 84 | # of repeats: 5 | DPMQ: $9,875.19 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Zejula | |||||
Manner of administration:Oral
Restriction
Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Initial first-line maintenance therapy (BRCA1/2 gene mutation) in a patient requiring
a daily dose of 3 tablets
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 84 | # of repeats: 2 | DPMQ: $9,875.19 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Zejula | |||||
Manner of administration:Oral
Restriction
Indication: High grade stage III/IV epithelial ovarian, fallopian tube or primary peritoneal cancer
Treatment phase: Initial first-line maintenance therapy (genomic instability without BRCA1/2 gene mutation)
in a patient requiring a daily dose of 3 tablets
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 84 | # of repeats: 2 | DPMQ: $9,875.19 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Zejula | |||||