MEDROXYPROGESTERONE

medroxyprogesterone acetate 200 mg tablet, 60
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Breast cancer

Restriction

Indication: Endometrial cancer
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 120 # of repeats: 2 DPMQ: $183.46 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Provera
medroxyprogesterone acetate 200 mg tablet, 60
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Breast cancer

Restriction

Indication: Endometrial cancer
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 2 DPMQ: $96.97 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Provera