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	$433.47	$41.30	$41.30
	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	$469.17	$41.30	$41.30
	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	$1685.13	$41.30	$41.30
	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	$2503.83	$41.30	$41.30
	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	$1275.78	$41.30	$41.30
	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	$859.20	$41.30	$41.30
	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	$1353.33	$41.30	$41.30
	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	$923.52	$41.30	$41.30
	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)/0.5 mL injection, 0.5 mL pen device (PI, CMI)	2	2	0	$234.80	$41.30	$41.30
	Available brands
	Gonal-f Pen

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)/0.75 mL injection, 0.75 mL pen device (PI, CMI)	2	2	0	$348.32	$41.30	$41.30
	Available brands
	Gonal-f Pen

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)/1.5 mL injection, 1.5 mL pen device (PI, CMI)	5	5	0	$1685.14	$41.30	$41.30
	Available brands
	Gonal-f Pen

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)/0.5 mL injection, 0.5 mL pen device (PI, CMI)	3	3	5	$376.74	$41.30	$41.30
	Available brands
	Gonal-f Pen

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)/0.75 mL injection, 0.75 mL pen device (PI, CMI)	3	3	5	$561.57	$41.30	$41.30
	Available brands
	Gonal-f Pen

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)/1.5 mL injection, 1.5 mL pen device (PI, CMI)	2	2	5	$746.46	$41.30	$41.30
	Available brands
	Gonal-f Pen