HYDROCORTISONE ACETATE

hydrocortisone acetate 1% cream, 50 g

HYDROCORTISONE ACETATE (5113D)

hydrocortisone acetate 1% cream, 50 g
5113D
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: 0 DPMQ: $16.70 Max safety net: $18.18 General Patient Charge: $20.97
Available brands
Cortic-DS 1%
Sigmacort
*Additional charge for this brand is $2.19
 DPMQ: $18.89 Max safety net: $18.18 General Patient Charge: $23.16