PROGESTERONE

PROGESTERONE (10930G)

progesterone 200 mg pessary, 42
10930G
Body System:
Manner of administration:Vaginal
S100 IVF
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4997)

Indication: Assisted Reproductive Technology
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 42 # of repeats: 0 DPMQ: $88.41 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Progesterone BNM 200
Utrogestan

PROGESTERONE (12598C)

progesterone 200 mg pessary, 42
12598C
Body System:
Manner of administration:Vaginal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 11835)

Indication: Prevention of preterm birth
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 42 # of repeats: 3 DPMQ: $95.00 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Progesterone BNM 200
Utrogestan