FOLLITROPIN ALFA

follitropin alfa 450 units (32.76 microgram)/0.72 mL injection, 0.72 mL pen device

FOLLITROPIN ALFA (6432M)

follitropin alfa 450 units (32.76 microgram)/0.72 mL injection, 0.72 mL pen device
6432M
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: 2 Max qty units: 2 # of repeats: 0 DPMQ: $278.52 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Gonal-f Pen