GLOFITAMAB

GLOFITAMAB (15250P)

Glofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial
15250P
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 8)
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 2500 mcg # of repeats: 0 DPMA: $1,407.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Columvi
(Glofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial)

GLOFITAMAB (15269P)

Glofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial
15269P
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 8)
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 2500 mcg # of repeats: 0 DPMA: $1,471.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Columvi
(Glofitamab 2.5 mg/2.5 mL injection, 2.5 mL vial)