MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $51.38 $31.60 $31.60
Available brands
Momasonea
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $35.30B
10 10 5 $86.68 $31.60 $66.90
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $51.38 $31.60 $31.60
Available brands
Momasone Alcohol Freea
Novasonea
Elocon Alcohol Freea
* Additional charge for this brand is $35.30B
10 10 5 $86.68 $31.60 $66.90
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $43.84 $31.60 $31.60
Available brands
Momasonea
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $28.24B
8 8 5 $72.08 $31.60 $59.84
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $39.93 $31.60 $31.60
Available brands
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $22.50B
5 5 5 $62.43 $31.60 $54.10
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $34.72 $31.60 $31.60
Available brands
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $18.00B
4 4 5 $52.72 $31.60 $49.60
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $28.84 $30.32 $31.60
Available brands
Momasone Alcohol Freea
Novasonea
Elocon Alcohol Freea
* Additional charge for this brand is $14.12B
4 4 5 $42.96 $30.32 $45.72
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $21.32 $22.80 $26.25
Available brands
Momasonea
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $7.06B
2 2 5 $28.38 $22.80 $33.31
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $28.84 $30.32 $31.60
Available brands
Momasonea
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $14.12B
4 4 5 $42.96 $30.32 $45.72
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $36.36 $31.60 $31.60
Available brands
Momasone Alcohol Freea
Novasonea
Elocon Alcohol Freea
* Additional charge for this brand is $21.18B
6 6 5 $57.54 $31.60 $52.78
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $43.84 $31.60 $31.60
Available brands
Momasone Alcohol Freea
Novasonea
Elocon Alcohol Freea
* Additional charge for this brand is $28.24B
8 8 5 $72.08 $31.60 $59.84
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $24.26 $25.74 $29.19
Available brands
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $9.00B
2 2 5 $33.26 $25.74 $38.19
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $29.49 $30.97 $31.60
Available brands
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $13.50B
3 3 5 $42.99 $30.97 $45.10
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $21.32 $22.80 $26.25
Available brands
Momasone Alcohol Freea
Novasonea
Elocon Alcohol Freea
* Additional charge for this brand is $7.06B
2 2 5 $28.38 $22.80 $33.31
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $36.36 $31.60 $31.60
Available brands
Momasonea
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $21.18B
6 6 5 $57.54 $31.60 $52.78
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $17.55 $19.03 $22.48
Available brands
Momasone Alcohol Freea
Novasonea
Elocon Alcohol Freea
* Additional charge for this brand is $3.53B
1 1 0 $21.08 $19.03 $26.01
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $17.55 $19.03 $22.48
Available brands
Momasonea
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $3.53B
1 1 0 $21.08 $19.03 $26.01
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MOMETASONE

Source Repatriation Pharmaceutical Benefits
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $37.32 $7.70 $7.70
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MOMETASONE

Source Repatriation Pharmaceutical Benefits
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $37.32 $7.70 $7.70
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MOMETASONE

Source General Schedule
Body System DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN
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 $19.02 $20.50 $23.95
Available brands
Novasonea
Zatamila
Elocona
* Additional charge for this brand is $4.50B
1 1 0 $23.52 $20.50 $28.45
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  • Legend
  • RRepatriation Care items
  • BBrand premium applies
  • aBrand equivalent a
  • MPMedical Practitioner
  • NPNurse Practitioner