TESTOSTERONE

TESTOSTERONE (10378F)

testosterone 5% (50 mg/mL) cream, 50 mL
10378F
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: $107.87 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
AndroForte 5

TESTOSTERONE (10380H)

testosterone 1% (12.5 mg/actuation) gel, 2 x 60 actuations
10380H
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: 4 DPMQ: $79.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Testogel

TESTOSTERONE (11740X)

testosterone 2% (23 mg/actuation) gel, 56 actuations
11740X
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: 5 DPMQ: $84.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Testavan

TESTOSTERONE (13924W)

testosterone 1% (12.5 mg/actuation) gel, 2 x 60 actuations
13924W
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: 4 DPMQ: $146.34 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Testogel

TESTOSTERONE (13983Y)

testosterone 1% (50 mg/5 g) gel, 30 x 5 g sachets
13983Y
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: $146.34 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Testogel

TESTOSTERONE (14025E)

testosterone 2% (23 mg/actuation) gel, 56 actuations
14025E
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: $157.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Testavan

TESTOSTERONE (14563L)

testosterone 5% (50 mg/mL) cream, 50 mL
14563L
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: 1 DPMQ: $206.36 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
AndroForte 5

TESTOSTERONE (8830R)

testosterone 1% (50 mg/5 g) gel, 30 x 5 g sachets
8830R
Body System:
Manner of administration:Transdermal
General Schedule
Authority Required

Restriction

Indication: Androgen deficiency

Restriction

Indication: Androgen deficiency

Restriction

Indication: Micropenis

Restriction

Indication: Pubertal induction

Restriction

Indication: Constitutional delay of growth or puberty
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: 5 DPMQ: $79.29 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Testogel