SOMATROPIN
|
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|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10426RMP | SOMATROPIN somatropin 12 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 1 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10427TMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $171.28 | $31.60 | $31.60 |
| Available brands | |||||||
| Scitropin A |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10428WMP | SOMATROPIN somatropin 2 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $463.99 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10430YMP | SOMATROPIN somatropin 1 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $236.34 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10431BMP | SOMATROPIN somatropin 12 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 1 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10432CMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10434EMP | SOMATROPIN somatropin 1.4 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $327.40 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10435FMP | SOMATROPIN somatropin 5 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 1 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10441MMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| SciTropin A |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10442NMP | SOMATROPIN somatropin 20 mg/2.5 mL injection, 2.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $659.14 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
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|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10443PMP | SOMATROPIN somatropin 5 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 1 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10446TMP | SOMATROPIN somatropin 15 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $496.51 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 15 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10449YMP | SOMATROPIN somatropin 15 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $496.51 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10451CMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
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|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10453EMP | SOMATROPIN somatropin 1.2 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $281.87 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
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| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10454FMP | SOMATROPIN somatropin 1.6 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $372.93 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
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|
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| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10456HMP | SOMATROPIN somatropin 600 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $145.27 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10457JMP | SOMATROPIN somatropin 1.2 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $281.87 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10458KMP | SOMATROPIN somatropin 6 mg/1.03 mL injection, 1.03 mL cartridge (PI, CMI) |
1 | 1 | 1 | $197.75 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10462PMP | SOMATROPIN somatropin 6 mg/1.03 mL injection, 1.03 mL cartridge (PI, CMI) |
1 | 1 | 1 | $197.75 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10463QMP | SOMATROPIN somatropin 800 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $190.81 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10467XMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10472EMP | SOMATROPIN somatropin 2 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $463.99 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10477KMP | SOMATROPIN somatropin 600 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $145.27 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10479MMP | SOMATROPIN somatropin 800 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $190.81 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10480NMP | SOMATROPIN somatropin 1 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $236.34 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10481PMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| SciTropin A |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10483RMP | SOMATROPIN somatropin 12 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10484TMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $171.28 | $31.60 | $31.60 |
| Available brands | |||||||
| Scitropin A |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10485WMP | SOMATROPIN somatropin 15 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $496.51 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 15 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10488BMP | SOMATROPIN somatropin 1.4 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $327.40 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10489CMP | SOMATROPIN somatropin 15 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $496.51 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10490DMP | SOMATROPIN somatropin 15 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $496.51 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 15 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10495JMP | SOMATROPIN somatropin 12 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10496KMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10497LMP | SOMATROPIN somatropin 20 mg/2.5 mL injection, 2.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $659.14 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10498MMP | SOMATROPIN somatropin 1.6 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $372.93 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10500PMP | SOMATROPIN somatropin 1.8 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $418.46 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10501QMP | SOMATROPIN somatropin 1.8 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $418.46 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10506YMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 10 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10507BMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $171.28 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 5 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10512GMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $171.28 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 5 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10514JMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 10 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10518NMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $171.28 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 5 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10519PMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| Omnitrope Surepal 10 |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10891FMP | SOMATROPIN somatropin 400 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $100.23 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10902TMP | SOMATROPIN somatropin 400 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $100.23 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 10908DMP | SOMATROPIN somatropin 400 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $100.23 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 11493XMP | SOMATROPIN somatropin 5 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 5 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 11495BMP | SOMATROPIN somatropin 12 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 5 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 11895CMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 5 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 13709MMP | SOMATROPIN somatropin 12 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 5 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 13712QMP | SOMATROPIN somatropin 6 mg/1.03 mL injection, 1.03 mL cartridge (PI, CMI) |
1 | 1 | 5 | $197.75 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 3388HMP | SOMATROPIN somatropin 20 mg/2.5 mL injection, 2.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $659.14 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 5818FMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 5819GMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 5820HMP | SOMATROPIN somatropin 15 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $496.51 | $31.60 | $31.60 |
| Available brands | |||||||
| Norditropin FlexPro |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 5822KMP | SOMATROPIN somatropin 6 mg/1.03 mL injection, 1.03 mL cartridge (PI, CMI) |
1 | 1 | 1 | $197.75 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 5824MMP | SOMATROPIN somatropin 12 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Saizen |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6311EMP | SOMATROPIN somatropin 10 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $333.90 | $31.60 | $31.60 |
| Available brands | |||||||
| SciTropin A |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6313GMP | SOMATROPIN somatropin 800 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $190.81 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6314HMP | SOMATROPIN somatropin 1 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $236.34 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6315JMP | SOMATROPIN somatropin 1.2 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $281.87 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6316KMP | SOMATROPIN somatropin 1.4 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $327.40 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6317LMP | SOMATROPIN somatropin 1.6 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $372.93 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6318MMP | SOMATROPIN somatropin 1.8 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $418.46 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6319NMP | SOMATROPIN somatropin 2 mg injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $463.99 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 6476WMP | SOMATROPIN somatropin 5 mg/1.5 mL injection, 1.5 mL cartridge (PI, CMI) |
1 | 1 | 1 | $171.28 | $31.60 | $31.60 |
| Available brands | |||||||
| Scitropin A |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 9585LMP | SOMATROPIN somatropin 5 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 1 | $166.24 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 9586MMP | SOMATROPIN somatropin 12 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber pen device (PI, CMI) |
1 | 1 | 1 | $386.83 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin GoQuick |
SOMATROPIN
|
|
|
|
| Code & Prescriber |
Medicinal Product Pack (Name, form & strength and pack size) |
Max qty packs | Max qty units | No. of repeats | DPMQ | Max Safety Net | General Patient Charge |
|---|---|---|---|---|---|---|---|
| 9628RMP | SOMATROPIN somatropin 600 microgram injection [1 chamber] (&) inert substance diluent [0.25 mL chamber], 7 dual chamber syringes (PI, CMI) |
1 | 7 | 1 | $145.27 | $31.60 | $31.60 |
| Available brands | |||||||
| Genotropin MiniQuick |
- Legend
- MPMedical Practitioner
