CYPROTERONE

CYPROTERONE (14022B)

cyproterone acetate 100 mg tablet, 50
14022B
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: 100 # of repeats: 5 DPMQ: $109.42 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ANTERONE 100
Cyproterone Sandoz
Androcur-100
*Additional charge for this brand is $2.42
 DPMQ: $111.84 Max safety net: $25.00 General Patient Charge: $27.42

CYPROTERONE (8019C)

cyproterone acetate 100 mg tablet, 50
8019C
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: 50 # of repeats: 5 DPMQ: $61.60 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ANTERONE 100
Cyproterone Sandoz
Androcur-100
*Additional charge for this brand is $1.21
 DPMQ: $62.81 Max safety net: $25.00 General Patient Charge: $26.21