Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

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
13849XMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 30 (PI, CMI)	2	60	2	$27.54	$25.00	$25.00
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $13.40B	2	60	2	$40.94	$25.00	$38.40

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

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
13928CMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 100 (PI, CMI)	2	200	2	$59.60	$25.00	$25.00
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $13.40B	2	200	2	$73.00	$25.00	$38.40

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

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
13956MMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 5 mg tablet, 56 (PI, CMI)	2	112	2	$24.76	$25.00	$25.00
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $9.16B	2	112	2	$33.92	$25.00	$34.16

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

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
2321EMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 30 (PI, CMI)	1	30	2	$20.66	$22.14	$24.93
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $6.70B	1	30	2	$27.36	$22.14	$31.63

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

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
2323GMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 5 mg tablet, 56 (PI, CMI)	1	56	2	$19.27	$20.75	$23.54
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $4.58B	1	56	2	$23.85	$20.75	$28.12

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > PROGESTOGENS

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
2722GMPNP	MEDROXYPROGESTERONE medroxyprogesterone acetate 10 mg tablet, 100 (PI, CMI)	1	100	2	$36.69	$25.00	$25.00
	Available brands
	Raloveraa
	Proveraa * Additional charge for this brand is $6.70B	1	100	2	$43.39	$25.00	$31.70