FOLLITROPIN ALFA

follitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge

FOLLITROPIN ALFA (12770D)

follitropin alfa 900 units (66 microgram)/1.5 mL injection, 1.5 mL cartridge
12770D
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: 5 Max qty units: 5 # of repeats: 0 DPMQ: $1,686.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Ovaleap