NIVOLUMAB + RELATLIMAB

NIVOLUMAB + RELATLIMAB (14664T)

nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial
14664T
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16881)

Indication: Unresectable Stage III or Stage IV malignant melanoma
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 8 DPMA: $18,587.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdualag
(nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial)

NIVOLUMAB + RELATLIMAB (14676K)

nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial
14676K
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16151)

Indication: Unresectable Stage III 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: 11 DPMA: $18,287.03 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdualag
(nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial)

NIVOLUMAB + RELATLIMAB (14677L)

nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial
14677L
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16151)

Indication: Unresectable Stage III 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: 11 DPMA: $18,587.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdualag
(nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial)

NIVOLUMAB + RELATLIMAB (14678M)

nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial
14678M
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16881)

Indication: Unresectable Stage III or Stage IV malignant melanoma
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 480 mg # of repeats: 8 DPMA: $18,287.03 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Opdualag
(nivolumab 240 mg/20 mL + relatlimab 80 mg/20 mL injection, 20 mL vial)