FOLLITROPIN ALFA
follitropin alfa 300 units (21.84 microgram)/0.48 mL injection, 0.48 mL pen device
FOLLITROPIN ALFA (8713N)
8713N
Manner of administration:Injection
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: 3 | Max qty units: 3 | # of repeats: 5 | DPMQ: $301.50 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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