ODEVIXIBAT
Body System:
Manner of administration:Oral
Restriction
Indication: Progressive familial intrahepatic cholestasis (PFIC)
Treatment phase: Continuing treatment (PFIC diagnosed prior to turning 18 years of age)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 5 | DPMQ: $67,122.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Bylvay | |||||
Body System:
Manner of administration:Oral
Restriction
Indication: Progressive familial intrahepatic cholestasis (PFIC)
Treatment phase: Dose modification (Dose escalation from initial treatment phase; for PFIC diagnosed
prior to turning 18 years of age)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 4 | DPMQ: $67,122.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Bylvay | |||||
Body System:
Manner of administration:Oral
Restriction
Indication: Progressive familial intrahepatic cholestasis (PFIC)
Treatment phase: Continuing treatment (PFIC diagnosed after turning 18 years of age)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 5 | DPMQ: $67,122.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Bylvay | |||||
Body System:
Manner of administration:Oral
Restriction
Indication: Progressive familial intrahepatic cholestasis (PFIC)
Treatment phase: Initial treatment (PFIC diagnosed prior to turning 18 years of age)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 2 | DPMQ: $67,122.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Bylvay | |||||
Body System:
Manner of administration:Oral
Restriction
Indication: Progressive familial intrahepatic cholestasis (PFIC)
Treatment phase: Dose modification (Dose escalation from initial treatment phase; for PFIC diagnosed
after turning 18 years of age)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 4 | DPMQ: $67,122.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Bylvay | |||||
Body System:
Manner of administration:Oral
Restriction
Indication: Progressive familial intrahepatic cholestasis (PFIC)
Treatment phase: Initial treatment (PFIC diagnosed after turning 18 years of age)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 2 | DPMQ: $67,122.90 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Bylvay | |||||