Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

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
10804PMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	5	5	5	$39.12	$31.60	$31.60
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $17.65B	5	5	5	$56.77	$31.60	$49.25

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

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
10805QMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	4	4	5	$33.93	$31.60	$31.60
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $14.12B	4	4	5	$48.05	$31.60	$45.72

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

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
10819KMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	2	2	5	$23.45	$24.85	$28.30
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $7.06B	2	2	5	$30.51	$24.85	$35.36

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

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
10826TMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	3	3	5	$28.68	$30.08	$31.60
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $10.59B	3	3	5	$39.27	$30.08	$42.19

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

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
8043HMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	1	1	0	$18.22	$19.62	$23.07
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $3.53B	1	1	0	$21.75	$19.62	$26.60