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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $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
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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 $35.67 $6.80 $6.80
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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 $35.67 $6.80 $6.80
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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 $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
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  • Legend
  • RRepatriation Care items
  • BBrand premium applies
  • aBrand equivalent a
  • MPMedical Practitioner
  • NPNurse Practitioner