VUTRISIRAN

VUTRISIRAN (14810L)

Vutrisiran 25 mg/0.5 mL injection, 0.5 mL syringe
14810L
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required

Restriction

Indication: Hereditary transthyretin amyloidosis
Treatment phase: Initial treatment

Restriction

Indication: Hereditary transthyretin amyloidosis
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: 1 DPMQ: $114,121.96 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amvuttra

VUTRISIRAN (14829L)

Vutrisiran 25 mg/0.5 mL injection, 0.5 mL syringe
14829L
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required

Restriction

Indication: Hereditary transthyretin amyloidosis
Treatment phase: Initial treatment

Restriction

Indication: Hereditary transthyretin amyloidosis
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: 1 DPMQ: $114,170.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amvuttra