CLADRIBINE

CLADRIBINE (11603Q)

cladribine 10 mg tablet, 1
11603Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16345)

Indication: Relapsing remitting multiple sclerosis
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 16299)

Indication: Relapsing remitting multiple sclerosis
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: 1 # of repeats: 1 DPMQ: $1,243.40 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
CLADRITAB
Mavenclad

CLADRIBINE (11604R)

cladribine 10 mg tablet, 4
11604R
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16345)

Indication: Relapsing remitting multiple sclerosis
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 16299)

Indication: Relapsing remitting multiple sclerosis
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 8 # of repeats: 1 DPMQ: $9,136.38 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
CLADRITAB
Mavenclad

CLADRIBINE (11611D)

cladribine 10 mg tablet, 6
11611D
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 16345)

Indication: Relapsing remitting multiple sclerosis
Treatment phase: Initial treatment

Restriction (Streamlined authority code: 16299)

Indication: Relapsing remitting multiple sclerosis
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: 6 # of repeats: 1 DPMQ: $6,893.01 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
CLADRITAB
Mavenclad

CLADRIBINE (4326Q)

4326Q
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6265)

Indication: Hairy cell leukaemia
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 17 mg # of repeats: 6 DPMA: $900.49 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Leustatin
(cladribine 10 mg/10 mL injection, 10 mL vial)
Litak
(cladribine 10 mg/5 mL injection, 5 mL vial)

CLADRIBINE (7225G)

7225G
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6265)

Indication: Hairy cell leukaemia
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 17 mg # of repeats: 6 DPMA: $957.48 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Leustatin
(cladribine 10 mg/10 mL injection, 10 mL vial)
Litak
(cladribine 10 mg/5 mL injection, 5 mL vial)