Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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	$329.04	$31.60	$31.60
	Available brands
	Bemfola

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

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
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	$356.37	$31.60	$31.60
	Available brands
	Bemfola

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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	$1280.37	$31.60	$31.60
	Available brands
	Bemfola

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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	$1896.09	$31.60	$31.60
	Available brands
	Bemfola

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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	$969.42	$31.60	$31.60
	Available brands
	Bemfola

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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	$649.26	$31.60	$31.60
	Available brands
	Bemfola

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

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
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	$1035.45	$31.60	$31.60
	Available brands
	Bemfola

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

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
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	$703.92	$31.60	$31.60
	Available brands
	Bemfola

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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
6431LMP	FOLLITROPIN ALFA follitropin alfa 300 units (21.84 microgram)/0.48 mL injection, 0.48 mL pen device (PI, CMI)	2	2	0	$188.64	$31.60	$31.60
	Available brands
	Gonal-f Pena

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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
6432MMP	FOLLITROPIN ALFA follitropin alfa 450 units (32.76 microgram)/0.72 mL injection, 0.72 mL pen device (PI, CMI)	2	2	0	$278.52	$31.60	$31.60
	Available brands
	Gonal-f Pena

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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
6433NMP	FOLLITROPIN ALFA follitropin alfa 900 units (65.52 microgram)/1.44 mL injection, 1.44 mL pen device (PI, CMI)	5	5	0	$1686.28	$31.60	$31.60
	Available brands
	Gonal-f Pena

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

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
8713NMP	FOLLITROPIN ALFA follitropin alfa 300 units (21.84 microgram)/0.48 mL injection, 0.48 mL pen device (PI, CMI)	3	3	5	$301.50	$31.60	$31.60
	Available brands
	Gonal-f Pena

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

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
8714PMP	FOLLITROPIN ALFA follitropin alfa 450 units (32.76 microgram)/0.72 mL injection, 0.72 mL pen device (PI, CMI)	3	3	5	$447.84	$31.60	$31.60
	Available brands
	Gonal-f Pena

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

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
8715QMP	FOLLITROPIN ALFA follitropin alfa 900 units (65.52 microgram)/1.44 mL injection, 1.44 mL pen device (PI, CMI)	2	2	5	$748.22	$31.60	$31.60
	Available brands
	Gonal-f Pena