LEUPRORELIN

leuprorelin acetate 30 mg modified release injection [1 chamber] (&) inert substance diluent [1.5 mL chamber], 1 dual chamber syringe

LEUPRORELIN (8877F)

leuprorelin acetate 30 mg modified release injection [1 chamber] (&) inert substance diluent [1.5 mL chamber], 1 dual chamber syringe
8877F
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Locally advanced (stage C) or metastatic (stage D) carcinoma of the prostate
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 1 DPMQ: $940.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lucrin Depot 4 Month PDS