MEDROXYPROGESTERONE

MEDROXYPROGESTERONE (14067J)

medroxyprogesterone acetate 100 mg tablet, 100
14067J
Body System:
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: 200 # of repeats: 2 DPMQ: $161.94 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Provera

MEDROXYPROGESTERONE (2725K)

medroxyprogesterone acetate 100 mg tablet, 100
2725K
Body System:
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: 100 # of repeats: 2 DPMQ: $86.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Provera