HYDROCORTISONE ACETATE

hydrocortisone acetate 1% ointment, 50 g

HYDROCORTISONE ACETATE (2882Q)

hydrocortisone acetate 1% ointment, 50 g
2882Q
Body System:
Manner of administration:Application
General Schedule
Restricted Benefit

Restriction

Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 1 DPMQ: $17.10 Max safety net: $18.64 General Patient Charge: $21.43
Available brands
Cortic-DS 1%
Sigmacort
*Additional charge for this brand is $2.19
 DPMQ: $19.29 Max safety net: $18.64 General Patient Charge: $23.62