ESTRADIOL (&) ESTRADIOL + NORETHISTERONE ACETATE
estradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone
acetate 140 microgram/24 hours patch [4], 8
Manner of administration:Transdermal
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: 2 | # of repeats: 5 | DPMQ: $76.78 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Estalis sequi 50/140 | |||||
estradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone
acetate 250 microgram/24 hours patch [4], 8
Manner of administration:Transdermal
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: 2 | # of repeats: 5 | DPMQ: $73.46 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Estalis sequi 50/250 | |||||
estradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone
acetate 140 microgram/24 hours patch [4], 8
Manner of administration:Transdermal
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $45.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Estalis sequi 50/140 | |||||
estradiol 50 microgram/24 hours patch [4] (&) estradiol 50 microgram/24 hours + norethisterone
acetate 250 microgram/24 hours patch [4], 8
Manner of administration:Transdermal
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 1 | # of repeats: 5 | DPMQ: $43.62 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Estalis sequi 50/250 | |||||