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: $30.10 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 $14.56
 DPMQ: $44.66 Max safety net: $25.00 General Patient Charge: $39.56

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: $22.23 Max safety net: $23.77 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 $7.28
 DPMQ: $29.51 Max safety net: $23.77 General Patient Charge: $32.28