ADALIMUMAB
adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe
ADALIMUMAB (12357J)
12357J
Manner of administration:Injection
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: First continuing treatment
Restriction
Indication: Moderate to severe ulcerative colitis
Treatment phase: Continuing treatment - 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: 5 | DPMQ: $624.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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