| NAME |
BROLUCIZUMAB-DBLL 6MG/0.05ML INJ,OPH |
| VA GENERIC NAME |
BROLUCIZUMAB-DBLL |
| DOSAGE FORM |
INJ,SOLN |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR TEXT |
Restricted to ophthalmology/retinal specialists
|
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
6 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2023-01-17 00:00:00 |
| UNITS |
MG/0.05ML |
| NATIONAL FORMULARY NAME |
BROLUCIZUMAB-DBLL INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2019-10-18 00:00:00
- COPAY END DATE: 2022-11-23 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-11-24 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
BROLUCIZUMAB-DBLL 6MG/0.05ML OPH INJ |
| VA PRODUCT IDENTIFIER |
B0890 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
VI |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4038786 |
| EFFECTIVE DATE/TIME |
-
- 2019-10-18 00:00:00
- STATUS: ACTIVE
-
- 2023-01-17 00:00:00
- STATUS: INACTIVE
|
