BIMEKIZUMAB

BIMEKIZUMAB (13644D)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
13644D
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 1, Whole body (new patient)

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 2, Whole body (change or recommencement of treatment after a break in biological medicine of less than 5 years)

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 3, Whole body (recommencement of treatment after a break in biological medicine of more than 5 years)

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 1, Face, hand, foot (new patient)

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 2, Face, hand, foot (change or recommencement of treatment after a break in biological medicine of less than 5 years)

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 3, Face, hand, foot (recommencement of treatment after a break in biological medicine of more than 5 years)

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Initial treatment - Initial 1, Whole body or Face, hand, foot (new patient) or Initial 2, Whole body or Face, hand, foot (change or recommencement of treatment after a break in biological medicine of less than 5 years) or Initial 3, Whole body or Face, hand, foot (recommencement of treatment after a break in biological medicine of more than 5 years) - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 4 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (13652M)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
13652M
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Continuing treatment, Whole body

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Continuing treatment, Face, hand, foot

Restriction

Indication: Severe chronic plaque psoriasis
Treatment phase: Continuing treatment, Whole body or Continuing treatment, Face, hand, foot - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 2 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (14589W)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
14589W
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Non-radiographic axial spondyloarthritis
Treatment phase: Continuing treatment

Restriction

Indication: Non-radiographic axial spondyloarthritis
Treatment phase: Continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 2 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (14590X)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
14590X
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe psoriatic arthritis
Treatment phase: Continuing treatment

Restriction

Indication: Severe psoriatic arthritis
Treatment phase: Continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 2 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (14593C)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
14593C
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Non-radiographic axial spondyloarthritis
Treatment phase: Initial treatment - Initial 1 (New patient)

Restriction

Indication: Non-radiographic axial spondyloarthritis
Treatment phase: Initial treatment - Initial 2 (Change or recommencement of treatment after a break in biological medicine of less than 5 years)

Restriction

Indication: Non-radiographic axial spondyloarthritis
Treatment phase: Initial treatment - Initial 3 (Recommencement of treatment after a break in biological medicine of more than 5 years)

Restriction

Indication: Non-radiographic axial spondyloarthritis
Treatment phase: Initial 1 (New patient), Initial 2 (Change or recommencement of treatment after a break in biological medicine of less than 5 years) or Initial 3 (Recommencement of treatment after a break in biological medicine of more than 5 years) - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 1 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (14602M)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
14602M
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Ankylosing spondylitis
Treatment phase: Continuing treatment

Restriction

Indication: Ankylosing spondylitis
Treatment phase: Continuing treatment - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 2 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (14618J)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
14618J
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Ankylosing spondylitis
Treatment phase: Initial 1 (new patient)

Restriction

Indication: Ankylosing spondylitis
Treatment phase: Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 5 years)

Restriction

Indication: Ankylosing spondylitis
Treatment phase: Initial 3 (recommencement of treatment after a break in biological medicine of more than 5 years)

Restriction

Indication: Ankylosing spondylitis
Treatment phase: Initial 1 (new patient) or Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 5 years) or Initial 3 (recommencement of treatment after a break in biological medicine of more than 5 years) - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 1 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (14625R)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
14625R
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 1 (new patient)

Restriction

Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 5 years)

Restriction

Indication: Severe psoriatic arthritis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological medicine of more than 5 years)

Restriction

Indication: Severe psoriatic arthritis
Treatment phase: Initial 1 (new patient) or Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 5 years) or Initial 3 (recommencement of treatment after a break in biological medicine of more than 5 years) - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 2 # of repeats: 1 DPMQ: $3,395.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (15110G)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
15110G
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Moderate to severe hidradenitis suppurativa
Treatment phase: Initial 1 (new patient), Initial 2 (change or recommencement of treatment after a break in biological medicine of less than 5 years), or Initial 3 (recommencement of treatment after a break in biological medicine of more than 5 years) - balance of supply
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 4 # of repeats: 3 DPMQ: $6,682.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx

BIMEKIZUMAB (15116N)

bimekizumab 160 mg/mL injection, 2 x 1 mL pen devices
15116N
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Moderate to severe hidradenitis suppurativa
Treatment phase: Initial treatment - Initial 1 (new patient)

Restriction

Indication: Moderate to severe hidradenitis suppurativa
Treatment phase: Initial treatment - Initial 2 (Change or recommencement of treatment after a break in biological medicine of less than 5 years)

Restriction

Indication: Moderate to severe hidradenitis suppurativa
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological medicine of more than 5 years)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 4 # of repeats: 3 DPMQ: $6,682.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bimzelx