PERTUZUMAB

PERTUZUMAB (10267J)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10267J
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 840 mg # of repeats: 0 DPMA: $5,638.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (10308M)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10308M
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 420 mg # of repeats: 3 DPMA: $2,951.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (10333W)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10333W
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 420 mg # of repeats: 3 DPMA: $2,865.37 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (10334X)

pertuzumab 420 mg/14 mL injection, 14 mL vial
10334X
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Metastatic (Stage IV) HER2 positive breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 840 mg # of repeats: 0 DPMA: $5,762.81 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (15369X)

pertuzumab 420 mg/14 mL injection, 14 mL vial
15369X
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Early HER2 positive breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 420 mg # of repeats: 4 DPMA: $2,951.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (15386T)

pertuzumab 420 mg/14 mL injection, 14 mL vial
15386T
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Early HER2 positive breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 840 mg # of repeats: 0 DPMA: $5,638.18 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (15402P)

pertuzumab 420 mg/14 mL injection, 14 mL vial
15402P
Body System:
Manner of administration:Injection
Public
Chemotherapy Items for Public Hospital use
Authority Required

Restriction

Indication: Early HER2 positive breast cancer
Treatment phase: Continuing treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 420 mg # of repeats: 4 DPMA: $2,865.37 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)

PERTUZUMAB (15411D)

pertuzumab 420 mg/14 mL injection, 14 mL vial
15411D
Body System:
Manner of administration:Injection
Private
Chemotherapy Items for Private Hospital use
Authority Required

Restriction

Indication: Early HER2 positive breast cancer
Treatment phase: Initial treatment
Quantities & Cost
Max amount # of repeats DPMA Max safety net General Patient Charge
Max amount: 840 mg # of repeats: 0 DPMA: $5,762.81 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Perjeta
(pertuzumab 420 mg/14 mL injection, 14 mL vial)