CYPROTERONE

CYPROTERONE (1270W)

cyproterone acetate 50 mg tablet, 50
1270W
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 5 DPMQ: $73.92 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ANTERONE 50
Cyproterone Sandoz
Androcur
*Additional charge for this brand is $1.90
 DPMQ: $75.82 Max safety net: $25.00 General Patient Charge: $26.90

CYPROTERONE (14022B)

cyproterone acetate 100 mg tablet, 50
14022B
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 5 DPMQ: $107.12 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ANTERONE 100
Cyproterone Sandoz
Androcur-100
*Additional charge for this brand is $2.34
 DPMQ: $109.46 Max safety net: $25.00 General Patient Charge: $27.34

CYPROTERONE (14023C)

cyproterone acetate 50 mg tablet, 50
14023C
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 4 Max qty units: 200 # of repeats: 5 DPMQ: $134.44 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ANTERONE 50
Cyproterone Sandoz
Androcur
*Additional charge for this brand is $4.00
 DPMQ: $138.44 Max safety net: $25.00 General Patient Charge: $29.00

CYPROTERONE (8019C)

cyproterone acetate 100 mg tablet, 50
8019C
Body System:
Manner of administration:Oral
General Schedule
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 50 # of repeats: 5 DPMQ: $60.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ANTERONE 100
Cyproterone Sandoz
Androcur-100
*Additional charge for this brand is $1.17
 DPMQ: $61.91 Max safety net: $25.00 General Patient Charge: $26.17