LEUPRORELIN
leuprorelin acetate 45 mg modified release injection [1 chamber] (&) inert substance
diluent [1.5 mL chamber], 1 dual chamber syringe
Manner of administration:Injection
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: 0 | DPMQ: $1,377.51 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Lucrin Depot 6-Month | |||||
leuprorelin acetate 30 mg modified release injection [1 chamber] (&) inert substance
diluent [1.5 mL chamber], 1 dual chamber syringe
Manner of administration:Injection
Restriction
Indication: Central precocious puberty
Treatment phase: Continuing treatment with this drug, or, switching gonadotropin releasing hormone
analogue therapy
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: $714.05 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Lucrin Depot Paediatric 30 mg PDS | |||||
leuprorelin acetate 30 mg modified release injection [1 chamber] (&) inert substance
diluent [1.5 mL chamber], 1 dual chamber syringe
Manner of administration:Injection
Restriction
Indication: Central precocious puberty
Treatment phase: Initial treatment
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: $714.05 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Lucrin Depot Paediatric 30 mg PDS | |||||
leuprorelin acetate 45 mg modified release injection [1 syringe] (&) inert substance
diluent [1 syringe], 1 pack
Manner of administration:Injection
Restriction
Indication: Central precocious puberty
Treatment phase: Initial treatment
Restriction
Indication: Central precocious puberty
Treatment phase: Continuing treatment with this drug, or, switching gonadotropin releasing hormone
analogue therapy
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: 0 | DPMQ: $1,377.51 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eligard 6 month | |||||
leuprorelin acetate 7.5 mg modified release injection [1 syringe] (&) inert substance
diluent [1 syringe], 1 pack
Manner of administration:Injection
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: 5 | DPMQ: $271.33 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eligard 1 month | |||||
leuprorelin acetate 22.5 mg modified release injection [1 syringe] (&) inert substance
diluent [1 syringe], 1 pack
Manner of administration:Injection
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: $714.89 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eligard 3 month | |||||
leuprorelin acetate 30 mg modified release injection [1 syringe] (&) inert substance
diluent [1 syringe], 1 pack
Manner of administration:Injection
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 | |||||
| Eligard 4 month | |||||
leuprorelin acetate 45 mg modified release injection [1 syringe] (&) inert substance
diluent [1 syringe], 1 pack
Manner of administration:Injection
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: 0 | DPMQ: $1,377.51 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Eligard 6 month | |||||
leuprorelin acetate 7.5 mg modified release injection [1 chamber] (&) inert substance
diluent [1 mL chamber], 1 dual chamber syringe
Manner of administration:Injection
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: 5 | DPMQ: $271.33 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Lucrin Depot 7.5mg PDS | |||||
leuprorelin acetate 22.5 mg modified release injection [1 chamber] (&) inert substance
diluent [1.5 mL chamber], 1 dual chamber syringe
Manner of administration:Injection
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: $714.89 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Lucrin Depot 3 Month PDS | |||||