BROLUCIZUMAB-DBLL 6MG/0.05ML INJ,OPH,SYRINGE,0.05ML (32042)    VA PRODUCT (50.68)

Name Value
NAME BROLUCIZUMAB-DBLL 6MG/0.05ML INJ,OPH,SYRINGE,0.05ML
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
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
  • RxNorm
    CODE:
COPAY TIER
  • COPAY TIER LEVEL:   3
    COPAY EFFECTIVE DATE:   2022-06-09 00:00:00
PGX ELIGIBLE NO
PGX SUPPRESSED NO
VA PRINT NAME BROLUCIZUMAB-DBLL 6MG/0.05ML OPH INJ SYR
VA PRODUCT IDENTIFIER B0944
TRANSMIT TO CMOP NO
VA DISPENSE UNIT SYR
MASTER ENTRY FOR VUID YES
VUID 4041490
EFFECTIVE DATE/TIME
  • 2022-06-09 00:00:00
    STATUS:   ACTIVE