GLOFITAMAB

GLOFITAMAB (15227K)

Glofitamab 10 mg/10 mL injection, 10 mL vial
15227K
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Treatment phase: Continuing treatment (Cycles 2-12)

Restriction

Indication: Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Treatment phase: Transitioning from non-PBS to PBS-subsidised treatment - Grandfather arrangements
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 30000 mcg # of repeats: 10 DPMA: $16,156.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Columvi
(Glofitamab 10 mg/10 mL injection, 10 mL vial)

GLOFITAMAB (15228L)

Glofitamab 10 mg/10 mL injection, 10 mL vial
15228L
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Treatment phase: Initial treatment (Cycle 1, Day 15)
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 10000 mcg # of repeats: 0 DPMA: $5,357.33 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Columvi
(Glofitamab 10 mg/10 mL injection, 10 mL vial)

GLOFITAMAB (15249N)

Glofitamab 10 mg/10 mL injection, 10 mL vial
15249N
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Treatment phase: Continuing treatment (Cycles 2-12)

Restriction

Indication: Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Treatment phase: Transitioning from non-PBS to PBS-subsidised treatment - Grandfather arrangements
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 30000 mcg # of repeats: 10 DPMA: $15,889.53 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Columvi
(Glofitamab 10 mg/10 mL injection, 10 mL vial)

GLOFITAMAB (15266L)

Glofitamab 10 mg/10 mL injection, 10 mL vial
15266L
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Relapsed or refractory diffuse large B-cell lymphoma (DLBCL)
Treatment phase: Initial treatment (Cycle 1, Day 15)
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 10000 mcg # of repeats: 0 DPMA: $5,476.73 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Columvi
(Glofitamab 10 mg/10 mL injection, 10 mL vial)