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	$49.72	$42.50	$42.50
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $35.30B	10	10	5	$85.02	$42.50	$77.80

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	$49.72	$42.50	$42.50
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $35.30B	10	10	5	$85.02	$42.50	$77.80

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	$42.22	$42.50	$42.50
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $28.24B	8	8	5	$70.46	$42.50	$70.74

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	$38.27	$39.58	$42.50
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $17.65B	5	5	5	$55.92	$39.58	$60.15

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	$33.06	$34.37	$38.91
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $14.12B	4	4	5	$47.18	$34.37	$53.03

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	$27.18	$28.49	$33.03
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $14.12B	4	4	5	$41.30	$28.49	$47.15

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	$19.66	$20.97	$25.51
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $7.06B	2	2	5	$26.72	$20.97	$32.57

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	$27.18	$28.49	$33.03
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $14.12B	4	4	5	$41.30	$28.49	$47.15

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	$34.70	$36.01	$40.55
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $21.18B	6	6	5	$55.88	$36.01	$61.73

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	$42.22	$42.50	$42.50
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $28.24B	8	8	5	$70.46	$42.50	$70.74

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	$22.60	$23.91	$28.45
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $7.06B	2	2	5	$29.66	$23.91	$35.51

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	$27.83	$29.14	$33.68
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $10.59B	3	3	5	$38.42	$29.14	$44.27

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	$19.66	$20.97	$25.51
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $7.06B	2	2	5	$26.72	$20.97	$32.57

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	$34.70	$36.01	$40.55
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $21.18B	6	6	5	$55.88	$36.01	$61.73

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	$15.90	$17.21	$21.75
	Available brands
	Momasone Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $3.53B	1	1	0	$19.43	$17.21	$25.28

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	$15.90	$17.21	$21.75
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $3.53B	1	1	0	$19.43	$17.21	$25.28

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	$35.67	$6.80	$6.80

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	$35.67	$6.80	$6.80

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	$17.37	$18.68	$23.22
	Available brands
	Momasonea
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $3.53B	1	1	0	$20.90	$18.68	$26.75