FILGRASTIM

FILGRASTIM (5744H)

filgrastim 480 microgram/0.5 mL injection, 10 x 0.5 mL syringes
5744H
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7822)

Indication: Chemotherapy-induced neutropenia

Restriction (Streamlined authority code: 7843)

Indication: Chemotherapy-induced neutropenia

Restriction (Streamlined authority code: 6653)

Indication: Mobilisation of peripheral blood progenitor cells

Restriction (Streamlined authority code: 6654)

Indication: Mobilisation of peripheral blood progenitor cells

Restriction (Streamlined authority code: 6679)

Indication: Assisting bone marrow transplantation

Restriction (Streamlined authority code: 6655)

Indication: Assisting autologous peripheral blood progenitor cell transplantation

Restriction (Streamlined authority code: 6680)

Indication: Severe congenital neutropenia

Restriction (Streamlined authority code: 6621)

Indication: Severe chronic neutropenia

Restriction (Streamlined authority code: 6640)

Indication: Chronic cyclical neutropenia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 20 # of repeats: 11 DPMQ: $376.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Nivestim

FILGRASTIM (6292E)

filgrastim 480 microgram/0.5 mL injection, 10 x 0.5 mL syringes
6292E
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 8674)

Indication: Chemotherapy-induced neutropenia

Restriction (Streamlined authority code: 8667)

Indication: Chemotherapy-induced neutropenia

Restriction (Streamlined authority code: 8672)

Indication: Mobilisation of peripheral blood progenitor cells

Restriction (Streamlined authority code: 8668)

Indication: Mobilisation of peripheral blood progenitor cells

Restriction (Streamlined authority code: 8671)

Indication: Assisting bone marrow transplantation

Restriction (Streamlined authority code: 8696)

Indication: Assisting autologous peripheral blood progenitor cell transplantation

Restriction (Streamlined authority code: 8669)

Indication: Severe congenital neutropenia

Restriction (Streamlined authority code: 8670)

Indication: Severe chronic neutropenia

Restriction (Streamlined authority code: 8673)

Indication: Chronic cyclical neutropenia
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 20 # of repeats: 11 DPMQ: $400.54 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Nivestim