FOLLITROPIN ALFA

follitropin alfa 450 units (33 microgram)/0.75 mL injection, 5 x 0.75 mL pen devices

FOLLITROPIN ALFA (10867Y)

follitropin alfa 450 units (33 microgram)/0.75 mL injection, 5 x 0.75 mL pen devices
10867Y
Body System:
Manner of administration:Injection
S100 IVF
Authority Required (STREAMLINED)

Restriction  5027

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: 15 # of repeats: 0 DPMQ: $1,896.09 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bemfola