Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Restricted Benefit

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
12769CMP	FOLLITROPIN ALFA follitropin alfa 300 units (22 microgram)/0.5 mL injection, 0.5 mL cartridge (PI, CMI)	3	3	5	$301.17	$31.60	$31.60
	Available brands
	Ovaleapa

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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
12770DMP	FOLLITROPIN ALFA follitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge (PI, CMI)	5	5	0	$1686.07	$31.60	$31.60
	Available brands
	Ovaleapa

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Restricted Benefit

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
12778MMP	FOLLITROPIN ALFA follitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge (PI, CMI)	2	2	5	$747.89	$31.60	$31.60
	Available brands
	Ovaleapa

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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
12779NMP	FOLLITROPIN ALFA follitropin alfa 300 units (22 microgram)/0.5 mL injection, 0.5 mL cartridge (PI, CMI)	2	2	0	$188.43	$31.60	$31.60
	Available brands
	Ovaleapa

Source	S100 IVF
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Authority Required (STREAMLINED)

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
12800QMP	FOLLITROPIN ALFA follitropin alfa 450 units (33 microgram)/0.75 mL injection, 0.75 mL cartridge (PI, CMI)	2	2	0	$278.31	$31.60	$31.60
	Available brands
	Ovaleapa

Source	General Schedule
Body System	GENITO URINARY SYSTEM AND SEX HORMONES > SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM > GONADOTROPINS AND OTHER OVULATION STIMULANTS

Note

Restricted Benefit

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
12808DMP	FOLLITROPIN ALFA follitropin alfa 450 units (33 microgram)/0.75 mL injection, 0.75 mL cartridge (PI, CMI)	3	3	5	$447.51	$31.60	$31.60
	Available brands
	Ovaleapa