ADALIMUMAB
adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe
ADALIMUMAB (12350B)
12350B
Manner of administration:Injection
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Initial treatment - Initial 1 (new patient)
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Initial treatment - Initial 2 (change or recommencement of treatment after a break
in biological medicine of less than 5 years)
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Initial treatment - Initial 3 (recommencement of treatment after a break in biological
medicine of more than 5 years)
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Initial 1 (new patient) or Initial 2 (change or recommencement of treatment after
a break in biological medicine of less than 5 years) or Initial 3 (recommencement
of treatment after a break in biological medicine of more than 5 years) - balance
of supply
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 3 | DPMQ: $624.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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