Source	General Schedule
Body System	ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS > ENDOCRINE THERAPY > HORMONES AND RELATED AGENTS

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
8876EMP	LEUPRORELIN leuprorelin acetate 22.5 mg modified release injection [1 chamber] (&) inert substance diluent [1.5 mL chamber], 1 dual chamber syringe (PI, CMI)	1	1	1	$714.09	$31.60	$31.60
	Available brands
	Lucrin Depot 3 Month PDS