DUPILUMAB

DUPILUMAB (15035H)

dupilumab 200 mg/1.14 mL injection, 2 x 1.14 mL pen devices
15035H
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Chronic severe atopic dermatitis
Treatment phase: Initial treatment of the whole body

Restriction

Indication: Chronic severe atopic dermatitis
Treatment phase: Continuing or resuming treatment of the whole body

Restriction

Indication: Chronic severe atopic dermatitis
Treatment phase: Initial treatment of the face and/or hands

Restriction

Indication: Chronic severe atopic dermatitis
Treatment phase: Continuing or resuming treatment of the face and/or hands
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: 5 DPMQ: $1,755.99 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Dupixent