Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > OTHER GYNECOLOGICALS > CONTRACEPTIVES FOR TOPICAL USE

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
11909TMPMWNP	LEVONORGESTREL levonorgestrel 19.5 mg intrauterine drug delivery system, 1 system (PI, CMI)	1	1	0	$172.12	$31.60	$31.60
	Available brands
	Kyleena

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > OTHER GYNECOLOGICALS > CONTRACEPTIVES FOR TOPICAL USE

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
14705YMPMWNP	LEVONORGESTREL levonorgestrel 52 mg intrauterine drug delivery system, 1 system (PI, CMI)	1	1	0	$192.06	$31.60	$31.60
	Available brands
	Mirena

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > OTHER GYNECOLOGICALS > CONTRACEPTIVES FOR TOPICAL USE

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
8633JMPNP	LEVONORGESTREL levonorgestrel 52 mg intrauterine drug delivery system, 1 system (PI, CMI)	1	1	0	$192.06	$31.60	$31.60
	Available brands
	Mirena