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
1913QMPNP	MOMETASONE mometasone furoate 0.1% cream, 15 g (PI, CMI)	1	1	0	$17.55	$19.03	$21.82
	Available brands
	GLENMARK MOMETASONE Alcohol Freea
	Novasonea
	Elocon Alcohol Freea * Additional charge for this brand is $3.53B	1	1	0	$21.08	$19.03	$25.35

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
1915TMPNP	MOMETASONE mometasone furoate 0.1% ointment, 15 g (PI, CMI)	1	1	0	$17.55	$19.03	$21.82
	Available brands
	GLENMARK MOMETASONEa
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $3.53B	1	1	0	$21.08	$19.03	$25.35

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	$37.32	$7.70	$7.70

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	$37.32	$7.70	$7.70

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 $5.50B	1	1	0	$24.52	$20.50	$28.79