IMIQUIMOD

IMIQUIMOD (10106X)

imiquimod 5% cream, 2 x 2 g
10106X
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Solar keratosis
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: - Max safety net: - General Patient Charge: -
Available brands
Aldara Pump DPMQ: $95.72 Max safety net: $7.70 General Patient Charge: $7.70

IMIQUIMOD (2637T)

imiquimod 5% cream, 2 x 2 g
2637T
Body System:
Manner of administration:Application
General Schedule
Authority Required

Restriction

Indication: Superficial basal cell carcinoma
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: - Max safety net: - General Patient Charge: -
Available brands
Aldara Pump
*Additional charge for this brand is $8.09
 DPMQ: $95.72 Max safety net: $25.00 General Patient Charge: $33.09