ELEXACAFTOR + TEZACAFTOR + IVACAFTOR (&) IVACAFTOR
elexacaftor 80 mg + tezacaftor 40 mg + ivacaftor 60 mg granules [28] (&) ivacaftor
59.5 mg granules [28], 56
Manner of administration:Oral
Restriction
Indication: Cystic fibrosis
Treatment phase: Initial treatment
Restriction
Indication: Cystic fibrosis
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: 1 | # of repeats: 5 | DPMQ: $20,306.25 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Trikafta | |||||
elexacaftor 80 mg + tezacaftor 40 mg + ivacaftor 60 mg granules [28] (&) ivacaftor
59.5 mg granules [28], 56
Manner of administration:Oral
Restriction
Indication: Cystic fibrosis
Treatment phase: Initial treatment
Restriction
Indication: Cystic fibrosis
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: 1 | # of repeats: 5 | DPMQ: $20,355.13 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Trikafta | |||||