LEVONORGESTREL + ETHINYLESTRADIOL

LEVONORGESTREL + ETHINYLESTRADIOL (1392G)

levonorgestrel 50 microgram + ethinylestradiol 30 microgram tablet [6] (&) levonorgestrel 75 microgram + ethinylestradiol 40 microgram tablet [5] (&) levonorgestrel 125 microgram + ethinylestradiol 30 microgram tablet [10] (&) inert substance tablet [7], 4 x 28
1392G
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: 4 # of repeats: 2 DPMQ: $21.51 Max safety net: $22.99 General Patient Charge: $25.00
Available brands
Logynon ED
Trifeme 28
Triquilar ED
*Additional charge for this brand is $13.56
 DPMQ: $35.07 Max safety net: $22.99 General Patient Charge: $38.56

LEVONORGESTREL + ETHINYLESTRADIOL (1394J)

levonorgestrel 150 microgram + ethinylestradiol 30 microgram tablet [21] (&) inert substance tablet [7], 4 x 28
1394J
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: 4 # of repeats: 2 DPMQ: $18.20 Max safety net: $19.68 General Patient Charge: $22.47
Available brands
Eleanor 150/30 ED
Evelyn 150/30 ED
Femme-Tab ED 30/150
LEVETH 150/30 ED
Lenest 30 ED
Micronelle 30 ED
Levlen ED
*Additional charge for this brand is $5.66
 DPMQ: $23.86 Max safety net: $19.68 General Patient Charge: $28.13

LEVONORGESTREL + ETHINYLESTRADIOL (1456P)

levonorgestrel 125 microgram + ethinylestradiol 50 microgram tablet [21] (&) inert substance tablet [7], 4 x 28
1456P
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: 4 # of repeats: 2 DPMQ: $23.66 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Microgynon 50 ED

LEVONORGESTREL + ETHINYLESTRADIOL (2416E)

levonorgestrel 100 microgram + ethinylestradiol 20 microgram tablet [21] (&) inert substance tablet [7], 4 x 28
2416E
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: 4 # of repeats: 2 DPMQ: $19.90 Max safety net: $21.38 General Patient Charge: $24.17
Available brands
Femme-Tab ED 20/100