INFLIXIMAB

INFLIXIMAB (11450P)

infliximab 100 mg injection, 1 vial
11450P
Body System:
Manner of administration:Injection
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17117)

Indication: Moderate to severe Crohn disease
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: 5 Max qty units: 5 # of repeats: 2 DPMQ: $976.93 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Inflectra
Ixifi
Remsima
Renflexis