DOXORUBICIN HYDROCHLORIDE (AS PEGYLATED LIPOSOMAL)
Manner of administration:Injection
Quantities & Cost
| Max amount | # of repeats | DPMA | Max safety net | General Patient Charge |
|---|---|---|---|---|
| Max amount: 100 mg | # of repeats: 5 | DPMA: $750.37 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | ||||
| Caelyx
(doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial)
|
||||
| Caelyx
(doxorubicin hydrochloride (as pegylated liposomal) 50 mg/25 mL injection, 25 mL vial)
|
||||
| Liposomal Doxorubicin SUN
(doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial)
|
||||
| Liposomal Doxorubicin SUN
(doxorubicin hydrochloride (as pegylated liposomal) 50 mg/25 mL injection, 25 mL vial)
|
||||
doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial
Manner of administration:Injection
Restriction (Streamlined authority code: 6234)
Indication: Kaposi sarcoma
Restriction (Streamlined authority code: 6274)
Indication: Kaposi sarcoma
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $553.68 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
|
|
|||||
|
|
|||||
doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial
Manner of administration:Injection
Restriction (Streamlined authority code: 9287)
Indication: Kaposi sarcoma
Restriction (Streamlined authority code: 9223)
Indication: Kaposi sarcoma
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $584.72 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
|
|
|||||
|
|
|||||
Manner of administration:Injection
Quantities & Cost
| Max amount | # of repeats | DPMA | Max safety net | General Patient Charge |
|---|---|---|---|---|
| Max amount: 100 mg | # of repeats: 5 | DPMA: $805.26 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | ||||
| Caelyx
(doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial)
|
||||
| Caelyx
(doxorubicin hydrochloride (as pegylated liposomal) 50 mg/25 mL injection, 25 mL vial)
|
||||
| Liposomal Doxorubicin SUN
(doxorubicin hydrochloride (as pegylated liposomal) 20 mg/10 mL injection, 10 mL vial)
|
||||
| Liposomal Doxorubicin SUN
(doxorubicin hydrochloride (as pegylated liposomal) 50 mg/25 mL injection, 25 mL vial)
|
||||