Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ENDOCRINE THERAPY > HORMONES AND RELATED AGENTS

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
8875DMP	LEUPRORELIN leuprorelin acetate 7.5 mg modified release injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber syringe (PI, CMI)	1	1	5	$270.53	$31.60	$31.60
	Available brands
	Lucrin Depot 7.5mg PDS

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ENDOCRINE THERAPY > HORMONES AND RELATED AGENTS

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
8876EMP	LEUPRORELIN leuprorelin acetate 22.5 mg modified release injection [1 chamber] (&) inert substance diluent [1.5 mL chamber], 1 dual chamber syringe (PI, CMI)	1	1	1	$714.09	$31.60	$31.60
	Available brands
	Lucrin Depot 3 Month PDS

Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ENDOCRINE THERAPY > HORMONES AND RELATED AGENTS

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
8877FMP	LEUPRORELIN leuprorelin acetate 30 mg modified release injection [1 chamber] (&) inert substance diluent [1.5 mL chamber], 1 dual chamber syringe (PI, CMI)	1	1	1	$940.06	$31.60	$31.60
	Available brands
	Lucrin Depot 4 Month PDS