ADALIMUMAB

adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe

ADALIMUMAB (15005R)

adalimumab 20 mg/0.4 mL injection, 0.4 mL syringe
15005R
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction  17065

Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment, Whole body

Restriction  16999

Indication: Severe chronic plaque psoriasis
Treatment phase: Subsequent continuing treatment, Face, hand, foot
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