MEDROXYPROGESTERONE

MEDROXYPROGESTERONE (13956M)

medroxyprogesterone acetate 5 mg tablet, 56
13956M
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: 112 # of repeats: 2 DPMQ: $24.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ralovera
Provera
*Additional charge for this brand is $9.16
 DPMQ: $33.92 Max safety net: $25.00 General Patient Charge: $34.16

MEDROXYPROGESTERONE (2323G)

medroxyprogesterone acetate 5 mg tablet, 56
2323G
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: 56 # of repeats: 2 DPMQ: $19.27 Max safety net: $20.75 General Patient Charge: $23.54
Available brands
Ralovera
Provera
*Additional charge for this brand is $4.58
 DPMQ: $23.85 Max safety net: $20.75 General Patient Charge: $28.12