NIVOLUMAB

NIVOLUMAB (11900H)

11900H
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Stage IIIB, IIIC, IIID or Stage IV malignant melanoma
Treatment phase: Initial treatment

Restriction

Indication: Stage IIIB, IIIC, IIID or Stage IV malignant melanoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 5 DPMA: $9,560.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (11906P)

11906P
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Stage IIIB, IIIC, IIID or Stage IV malignant melanoma
Treatment phase: Initial treatment

Restriction

Indication: Stage IIIB, IIIC, IIID or Stage IV malignant melanoma
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 5 DPMA: $9,739.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (13240W)

13240W
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Adjuvant treatment of stage II or III oesophageal cancer or gastro-oesophageal junction cancer
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 5 DPMA: $9,560.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (13246E)

13246E
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Adjuvant treatment of stage II or III oesophageal cancer or gastro-oesophageal junction cancer
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 5 DPMA: $9,739.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (14231B)

14231B
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18370)

Indication: Urothelial carcinoma
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 5 DPMA: $9,560.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (14232C)

14232C
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15471)

Indication: Resectable non-small cell lung cancer (NSCLC)
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 360 mg # of repeats: 2 DPMA: $7,338.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (14233D)

14233D
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15471)

Indication: Resectable non-small cell lung cancer (NSCLC)
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 360 mg # of repeats: 2 DPMA: $7,193.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (14260M)

14260M
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18370)

Indication: Urothelial carcinoma
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 5 DPMA: $9,739.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (15224G)

15224G
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18070)

Indication: Immunotherapy sensitive advanced or metastatic cancer
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 13 DPMA: $9,739.06 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)

NIVOLUMAB (15238B)

15238B
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18070)

Indication: Immunotherapy sensitive advanced or metastatic cancer
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 13 DPMA: $9,560.79 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdivo
(nivolumab 40 mg/4 mL injection, 4 mL vial)
Opdivo
(nivolumab 100 mg/10 mL injection, 10 mL vial)