ESTRIOL

ESTRIOL (13926Y)

estriol 0.1% (1 mg/g) cream, 15 g
13926Y
Body System:
Manner of administration:Application
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: 2 # of repeats: 1 DPMQ: $36.32 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ovestin

ESTRIOL (14059Y)

estriol 500 microgram pessary, 15
14059Y
Body System:
Manner of administration:Vaginal
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: 2 # of repeats: 2 DPMQ: $39.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ovestin Ovula

ESTRIOL (1771F)

estriol 500 microgram pessary, 15
1771F
Body System:
Manner of administration:Vaginal
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: 1 # of repeats: 2 DPMQ: $26.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ovestin Ovula

ESTRIOL (1781R)

estriol 0.1% (1 mg/g) cream, 15 g
1781R
Body System:
Manner of administration:Application
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: 1 # of repeats: 1 DPMQ: $25.34 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ovestin