LETROZOLE

LETROZOLE (13939P)

letrozole 2.5 mg tablet, 30
13939P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Breast 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: 60 # of repeats: 5 DPMQ: $30.04 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-LETROZOLE
Femolet
Gynotril
LETROZOLE-WGR
Letrozole GH
Letrozole Sandoz
Pharmacor Letrozole 2.5
Femara 2.5 mg
*Additional charge for this brand is $15.00
 DPMQ: $45.04 Max safety net: $25.00 General Patient Charge: $40.00

LETROZOLE (8245Y)

letrozole 2.5 mg tablet, 30
8245Y
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Breast 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: 30 # of repeats: 5 DPMQ: $21.91 Max safety net: $23.39 General Patient Charge: $25.00
Available brands
ARX-LETROZOLE
Femolet
Gynotril
LETROZOLE-WGR
Letrozole GH
Letrozole Sandoz
Pharmacor Letrozole 2.5
Femara 2.5 mg
*Additional charge for this brand is $7.50
 DPMQ: $29.41 Max safety net: $23.39 General Patient Charge: $32.50