SELPERCATINIB

SELPERCATINIB (14693H)

Selpercatinib 40 mg capsule, 56
14693H
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16270)

Indication: Locally advanced or metastatic non-small cell lung cancer
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 56 # of repeats: 5 DPMQ: $2,137.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Retevmo

SELPERCATINIB (14703W)

selpercatinib 80 mg capsule, 56
14703W
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16282)

Indication: Locally advanced or metastatic non-small cell lung cancer
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 112 # of repeats: 5 DPMQ: $8,062.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Retevmo