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Kinase Inhibitor & Lymphocyte Growth Factor


$

KINASE INHIBITORS AND VEGF

for Leukemia

for Myelodysplastic Syndrome

for Soft Tissue Sarcoma

for Mastocytosis

for Renal Cancer

for Pancreatic Cancer

for Breast Cancer

for Rheumatoid Arthritis



FORMULARY-BEST PRICE

Print Coupon Category US Brand Name
Drug Info
Generic/
ingredient
Dosage Quantity Abroad
Brand Price
Abroad
Generic Price
US
Brand Price
US
Generic Price
Prior
Authorization
Price
per unit
____________________________________________________ ____________________________________________________________
WalmartKinase Inhibitor Zelboraf® sunitinib 240mg #240 Tablets $11465.60 Prior
Authorization
$47.77/ dose

WalmartKinase Inhibitor Zortress® everolimus 0.5mg #180 Tablets$ 955.00
#60
$  2522.71 General Prior
Authorization
$14.02/ dose

WalmartKinase Inhibitor Tykerb® lapatinib 250mg #30 Tablets$1350.00
for #70
$  1119.02 Prior
Authorization
$35.68/ dose

WalmartKinase Inhibitor Xeljanz® tofacitinib 5mg #60 Tablets $  2553.81 Prior
Authorization
$42.56/ dose

WalmartKinase Inhibitor Tasigna® nilotinib 200mg #28 Tablets $  2234.06 Prior
Authorization
$79.79/ dose

WalmartKinase Inhibitor Tafinlar® dabrafenib 75mg #120 Capsules $  8854.90Prior
Authorization
$73.80/ dose

WalmartKinase Inhibitor Tasigna® nilotinib 200mg #28 Tablets $  2234.06 Prior
Authorization
$79.79/ dose

WalmartKinase Inhibitor Zykadia® ceritinib 150mg #140 Capsules $13110.00 Prior
Authorization
$ 93.64/ dose

MeijerKinase Inhibitor Nexavar® sorafenib 200mg #120 Tablets$4999.00
for #112
$1969.00
for #120
$11320.50 General Prior
Authorization
$ 94.34/ dose

MeijerKinase Inhibitor Bosulif® bosutinib 200mg #120 Tablets $11320.50 Prior
Authorization
$ 94.34/ dose

WalmartKinase Inhibitor Imbruvica® ibrutinib 140mg #90 Capsules $  9305.30 Prior
Authorization
$103.39/ dose

WalmartKinase Inhibitor Xalkori® crizotinib 250mg #60 Capsules $12664.00 Prior
Authorization
$211.07/ dose

WalmartKinase Inhibitor Zydelig® idelalisib 150mg #30 Tablets $  3876.00 Prior
Authorization
$129.20/ dose

WalmartKinase Inhibitor Stivarga® regorafenib 40mg #84 Tablets $10958.70 Prior
Authorization
$130.46/ dose

WalmartKinase Inhibitor Sutent® sunitinib 12.5mg #28 Tablets$5249.00
for #84
$  3640.20 Prior
Authorization
$130.01/ dose

WalmartKinase Inhibitor Jakafi® ruxolitinib 20mg #60 Tablets $  9248.86Prior
Authorization
$154.15/ dose

WalmartKinase Inhibitor Inlyta® axitinib 5mg #60 Tablets$8499.00
#60
$10788.10Prior
Authorization
$179.80/ dose

MeijerKinase Inhibitor Iclusig® ponatinib 15mg #30 Tablets $  5470.84 Prior
Authorization
$182.36/ dose

Walmartkinase inhibitor Gilotrif® afatinib 40mg #30 Tablets $  6335.86Prior
Authorization
$211.20/ dose

WalmartKinase Inhibitor Gleevec® imatinib 100mg #30 Tablets$4463.00
#30
$944.00
for #90
$  8553.63 Prior
Authorization
$285.12/ dose

WalmartKinase Inhibitor Mekinist® trametinib 2mg #30 Tablets $10135.80 Prior
Authorization
$337.86/ dose

WalmartKinase Inhibitor Votrient® pazopanib 200mg #120 Tablets$3500.00
for #90
$  9990.00 Prior
Authorization
$356.79/ dose

WalmartKinase Inhibitor Sprycel® dasatinib 100mg #30 Tablets$5499.00
#60 for 50mg
$10510.00Prior
Authorization
$350.33/ dose

WalmartKinase Inhibitor Afinitor® everolimus 10mg #28 Tablets$4899.00
for #30
$11456.30 Prior
Authorization
$356.79/ dose

WalmartKinase Inhibitor Torisel® temsirolimus 25mg/ml #1 Kit $ 1532.11 General Prior
Authorization
$  1532.11/ kit

WalmartLymphocyte Growth Factor Proleukin® proleukin 1.3mg/ml #1 Kit $2528.26 General Prior
Authorization
$  2528.26/ kit

Rite-AidKinase Inhibitor Coellic® cobimetinib 20mg #63 Capsules $60372.35General Prior
Authorization
$101.15/ dose

Not AvailableMonoclonal Antibody Darzalex® daratumumab 20mg/ml #1000 ml injection General Prior
Authorization
physician dispenses

WalmartProteasome Inhibitor Empliciti® elotuzumb 300mg #1 Vial General Prior Authorization physician dispenses

Not AvailableMonoclonal Antibody Besponsa® inotuzmab/ ozogamicin 0.9mgl #1 vial injection General Prior
Authorization
physician dispenses

KrogerKinase Inhibitor Alunbrig® brigatinib 30mg #21 Tablets$7675.73 General Prior
Authorization
$365.50/ dose


OBSERVATION:


KEYWORDS:
Rx Gleevec, Rx imatinib, Rx Sprycel, Rx dasatinib, Rx Xeljanz, Rx tofacitinib, Rx Afinitor, Rx everolimus, Rx Zortress, Rx everolimus, Rx Sutent, Rx sunitinib, Rx Tasignna, Rx nilotinib, Rx Jakafi, Rx ruxolitinib, Rx Votrient, Rx pazopanib, Rx Nexavar, Rx sorafenib, Rx Tykerb, Rx lopatinib, Rx Xalkori, Rx crizotinib,, Rx Mekinist, Rx trametinib, Rx Inlyta, Rx axitinib, Rx Imbruvbica, Rx ibrutinib, Rx Tasigma, Rx nilotinib, Rx Tafinlar, Rx dabrafenib, Rx Stivarga, Rx regorafenib, Rx Zydelig, Rx idelalisib, Rx Iclusig, Rx ponatinib, Rx Caprelsa, Rx Torisel, Rx temsirolimus, Rx vandetanib, Rx proleukin, Rx lymphocyte growth factor, rx alectinib, rx alecensa, rx cotellic, rx cobimetinib, rx darzalex, rx daratumumab, rx empliciti, rx elotuzumab, rx besponsa, rx inotuzumab, rx ozogamic, rx alunbrig, rx brigatinib buy, BUY

Copyrighted® 2014: Revised May 1, 2015; Prices may vary