VANZACAFTOR + TEZACAFTOR + DEUTIVACAFTOR
vanzacaftor 10 mg + tezacaftor 50 mg + deutivacaftor 125 mg tablet, 56
Manner of administration:Oral
Restriction
Indication: Cystic fibrosis
Treatment phase: Initial treatment
Restriction
Indication: Cystic fibrosis
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: 56 | # of repeats: 5 | DPMQ: $21,423.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Alyftrek | |||||
vanzacaftor 10 mg + tezacaftor 50 mg + deutivacaftor 125 mg tablet, 56
Manner of administration:Oral
Restriction
Indication: Cystic fibrosis
Treatment phase: Initial treatment
Restriction
Indication: Cystic fibrosis
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: 56 | # of repeats: 5 | DPMQ: $21,375.00 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Alyftrek | |||||
vanzacaftor 4 mg + tezacaftor 20 mg + deutivacaftor 50 mg tablet, 84
Manner of administration:Oral
Restriction
Indication: Cystic fibrosis
Treatment phase: Initial treatment
Restriction
Indication: Cystic fibrosis
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: 84 | # of repeats: 5 | DPMQ: $21,423.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Alyftrek | |||||
vanzacaftor 4 mg + tezacaftor 20 mg + deutivacaftor 50 mg tablet, 84
Manner of administration:Oral
Restriction
Indication: Cystic fibrosis
Treatment phase: Initial treatment
Restriction
Indication: Cystic fibrosis
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: 84 | # of repeats: 5 | DPMQ: $21,375.00 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Alyftrek | |||||