FOLLITROPIN ALFA
| Source | S100 IVF |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10861PMP | FOLLITROPIN ALFA follitropin alfa 75 units (5.5 microgram)/0.125 mL injection, 5 x 0.125 mL pen devices (PI, CMI) |
3 | 15 | 0 | $327.98 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | General Schedule |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10865WMP | FOLLITROPIN ALFA follitropin alfa 75 units (5.5 microgram)/0.125 mL injection, 5 x 0.125 mL pen devices (PI, CMI) |
3 | 15 | 1 | $354.71 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | S100 IVF |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10866XMP | FOLLITROPIN ALFA follitropin alfa 300 units (22 microgram)/0.5 mL injection, 5 x 0.5 mL pen devices (PI, CMI) |
3 | 15 | 0 | $1279.31 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | S100 IVF |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10867YMP | FOLLITROPIN ALFA follitropin alfa 450 units (33 microgram)/0.75 mL injection, 5 x 0.75 mL pen devices (PI, CMI) |
3 | 15 | 0 | $1895.03 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | S100 IVF |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10872FMP | FOLLITROPIN ALFA follitropin alfa 225 units (16.5 microgram)/0.375 mL injection, 5 x 0.375 mL pen devices (PI, CMI) |
3 | 15 | 0 | $968.36 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | S100 IVF |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10873GMP | FOLLITROPIN ALFA follitropin alfa 150 units (11 microgram)/0.25 mL injection, 5 x 0.25 mL pen devices (PI, CMI) |
3 | 15 | 0 | $648.20 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | General Schedule |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10876KMP | FOLLITROPIN ALFA follitropin alfa 225 units (16.5 microgram)/0.375 mL injection, 5 x 0.375 mL pen devices (PI, CMI) |
3 | 15 | 1 | $1033.79 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
FOLLITROPIN ALFA
| Source | General Schedule |
| Body System | GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS |
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| 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 |
|---|---|---|---|---|---|---|---|
| 10877LMP | FOLLITROPIN ALFA follitropin alfa 150 units (11 microgram)/0.25 mL injection, 5 x 0.25 mL pen devices (PI, CMI) |
3 | 15 | 1 | $702.29 | $30.00 | $30.00 |
| Available brands | |||||||
| Bemfola |
- Legend
- MPMedical Practitioner
