PROGESTERONE

PROGESTERONE (12465C)

progesterone 200 mg pessary, 15
12465C
Body System:
Manner of administration:Vaginal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 11673)

Indication: Prevention of preterm birth
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 45 # of repeats: 3 DPMQ: $128.67 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Oripro

PROGESTERONE (9609R)

progesterone 200 mg pessary, 15
9609R
Body System:
Manner of administration:Vaginal
S100 IVF
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4997)

Indication: Assisted Reproductive Technology
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 45 # of repeats: 0 DPMQ: $119.34 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Oripro