ADALIMUMAB

adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe

ADALIMUMAB (12351C)

adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe
12351C
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction  16991

Indication: Moderate to severe ulcerative colitis
Treatment phase: Subsequent 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: 2 # of repeats: 5 DPMQ: $624.84 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Amgevita