PEGINTERFERON ALFA-2A

PEGINTERFERON ALFA-2A (11037X)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
11037X
Body System:
Manner of administration:Injection
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 4 # of repeats: 5 DPMQ: $1,073.25 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys

PEGINTERFERON ALFA-2A (14992C)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
14992C
Body System:
Manner of administration:Injection
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 4 # of repeats: 5 DPMQ: $1,359.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys (Ireland)

PEGINTERFERON ALFA-2A (14993D)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
14993D
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17022)

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 8 # of repeats: 5 DPMQ: $2,464.92 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys (Ireland)

PEGINTERFERON ALFA-2A (15036J)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
15036J
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17108)

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 8 # of repeats: 5 DPMQ: $2,513.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys (Ireland)

PEGINTERFERON ALFA-2A (6449K)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
6449K
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17108)

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 8 # of repeats: 5 DPMQ: $1,968.14 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys

PEGINTERFERON ALFA-2A (9516W)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
9516W
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17022)

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 8 # of repeats: 5 DPMQ: $1,919.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys