INFLIXIMAB

INFLIXIMAB (12550M)

infliximab 120 mg/mL injection, 1 mL syringe
12550M
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Moderate to severe ulcerative colitis
Treatment phase: Balance of supply for Initial treatment - subcutaneous form
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: 0 DPMQ: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12552P)

infliximab 120 mg/mL injection, 1 mL syringe
12552P
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17434)

Indication: Moderate to severe ulcerative colitis
Treatment phase: Continuing treatment with subcutaneous form or switching from intravenous form to subcutaneous form
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: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12553Q)

infliximab 120 mg/mL injection, 1 mL syringe
12553Q
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17551)

Indication: Severe active rheumatoid arthritis
Treatment phase: Continuing treatment with subcutaneous form or switching from intravenous form to subcutaneous form
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: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12555T)

infliximab 120 mg/mL injection, 1 mL syringe
12555T
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Balance of supply for Initial treatment - subcutaneous form
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 0 DPMQ: $373.83 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12561D)

infliximab 120 mg/mL injection, 1 mL syringe
12561D
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Moderate to severe ulcerative colitis
Treatment phase: Initial treatment with the subcutaneous form where a concurrent PBS authority application for the intravenously (IV) administered formulation is being made
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: 2 DPMQ: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12576X)

infliximab 120 mg/mL injection, 1 mL syringe
12576X
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe active rheumatoid arthritis
Treatment phase: Initial treatment with the subcutaneous form where a concurrent PBS authority application for the intravenously (IV) administered formulation is being made
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: 2 DPMQ: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12585J)

infliximab 120 mg/mL injection, 1 mL syringe
12585J
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe Crohn disease
Treatment phase: Initial 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: 2 DPMQ: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12586K)

infliximab 120 mg/mL injection, 1 mL syringe
12586K
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 18869)

Indication: Severe Crohn disease
Treatment phase: 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: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (12597B)

infliximab 120 mg/mL injection, 1 mL syringe
12597B
Body System:
Manner of administration:Injection
General Schedule
Authority Required

Restriction

Indication: Severe Crohn disease
Treatment phase: 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: 0 DPMQ: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC

INFLIXIMAB (13047Q)

infliximab 120 mg/mL injection, 1 mL syringe
13047Q
Body System:
Manner of administration:Injection
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17531)

Indication: Severe psoriatic arthritis
Treatment phase: Continuing treatment with subcutaneous form or switching from intravenous form to subcutaneous form
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: $738.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Remsima SC