FOLLITROPIN ALFA

follitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge

FOLLITROPIN ALFA (12778M)

follitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge
12778M
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Anovulatory infertility

Restriction

Indication: Infertility
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $748.22 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ovaleap