TOCILIZUMAB
tocilizumab 162 mg/0.9 mL injection, 4 x 0.9 mL syringes
TOCILIZUMAB (11730J)
11730J
Manner of administration:Injection
Restriction
Indication: Severe active juvenile idiopathic arthritis
Treatment phase: First continuing treatment
Restriction
Indication: Severe active juvenile idiopathic arthritis
Treatment phase: Subsequent continuing treatment
Restriction
Indication: Severe active juvenile idiopathic arthritis
Treatment phase: Balance of supply - 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: 4 | # of repeats: 5 | DPMQ: $760.99 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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