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
10791YMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	10	10	5	$50.57	$31.60	$31.60
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $35.30B	10	10	5	$85.87	$31.60	$66.90

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
10792BMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	10	10	5	$50.57	$31.60	$31.60
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $35.30B	10	10	5	$85.87	$31.60	$66.90

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
10793CMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	8	8	5	$43.09	$31.60	$31.60
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $28.24B	8	8	5	$71.33	$31.60	$59.84

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
10809XMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	4	4	5	$28.05	$29.45	$31.60
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $14.12B	4	4	5	$42.17	$29.45	$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
10812CMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	2	2	5	$20.51	$21.91	$25.36
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $7.06B	2	2	5	$27.57	$21.91	$32.42

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
10814EMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	4	4	5	$28.05	$29.45	$31.60
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $14.12B	4	4	5	$42.17	$29.45	$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
10815FMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	6	6	5	$35.55	$31.60	$31.60
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $21.18B	6	6	5	$56.73	$31.60	$52.78

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
10818JMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	8	8	5	$43.09	$31.60	$31.60
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $28.24B	8	8	5	$71.33	$31.60	$59.84

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

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
10827WMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	2	2	5	$20.51	$21.91	$25.36
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $7.06B	2	2	5	$27.57	$21.91	$32.42

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
10828XMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	6	6	5	$35.55	$31.60	$31.60
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $21.18B	6	6	5	$56.73	$31.60	$52.78

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
1913QMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	1	1	0	$16.75	$18.15	$21.60
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $3.53B	1	1	0	$20.28	$18.15	$25.13

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
1915TMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	1	1	0	$16.75	$18.15	$21.60
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $3.53B	1	1	0	$20.28	$18.15	$25.13

Source	Repatriation Pharmaceutical Benefits
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

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
4342MMP	MOMETASONER mometasone furoate 0.1% cream, 50 g (PI, CMI)
	Available brands
	Elocon Alcohol Free	1	1	0	$36.52	$7.70	$7.70

Source	Repatriation Pharmaceutical Benefits
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

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
4343NMP	MOMETASONER mometasone furoate 0.1% ointment, 50 g (PI, CMI)
	Available brands
	Elocon	1	1	0	$36.52	$7.70	$7.70

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