Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13849XMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 30 (PI, CMI)	2	60	2	$26.73	$28.13	$31.58
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $13.40B	2	60	2	$40.13	$28.13	$44.98

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13928CMP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 100 (PI, CMI)	2	200	2	$58.79	$31.60	$31.60
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $13.40B	2	200	2	$72.19	$31.60	$45.00

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
13956MMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 5 mg tablet, 56 (PI, CMI)	2	112	2	$23.95	$25.35	$28.80
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $9.16B	2	112	2	$33.11	$25.35	$37.96

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

Note

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2321EMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 30 (PI, CMI)	1	30	2	$19.86	$21.26	$24.71
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $6.70B	1	30	2	$26.56	$21.26	$31.41

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

Note

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2323GMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 5 mg tablet, 56 (PI, CMI)	1	56	2	$18.47	$19.87	$23.32
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $4.58B	1	56	2	$23.05	$19.87	$27.90

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
2722GMP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 100 (PI, CMI)	1	100	2	$35.89	$31.60	$31.60
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $6.70B	1	100	2	$42.59	$31.60	$38.30