№ lp_2_1_30049
Structured application form for hospital formulary submission detailing patient eligibility, dosage, licensing status, treatment rationale, alternative therapies, and financial implications for the addition of a new progesterone medicine.
Year: 2017
Region / City: United Kingdom
Document Type: Formulary Application
Department: Medicines Committee / Gynaecology
Applicant: Consultant (name not specified)
Speciality: Gynaecology
Intended Use: PMS, postnatal depression, perimenopause in patients with progestogen/progesterone intolerance
Dosage Form: Vaginal capsules 200mg
Regulatory Status: Off-label use
Estimated Patient Numbers: Not specified
Estimated Cost: £21.00 per 21 vaginal capsules
Supporting Evidence: Randomised controlled trials and peer-reviewed publications
Approval Required By: Divisional Medical Director, Lead Directorate Pharmacist
Signatures: Applicant, Divisional Medical Director, Lead Directorate Pharmacist
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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