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

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	$39.93	$25.00	$25.00
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $22.50B	5	5	5	$62.43	$25.00	$47.50

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

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	$34.72	$25.00	$25.00
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $18.00B	4	4	5	$52.72	$25.00	$43.00

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

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	$24.26	$25.00	$25.00
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $9.00B	2	2	5	$33.26	$25.00	$34.00

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

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	$29.49	$25.00	$25.00
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $13.50B	3	3	5	$42.99	$25.00	$38.50

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

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	$19.02	$20.50	$23.29
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $4.50B	1	1	0	$23.52	$20.50	$27.79