HYDROCORTISONE ACETATE

HYDROCORTISONE ACETATE (10831C)

hydrocortisone acetate 1% ointment, 30 g
10831C
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
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: - Max safety net: - General Patient Charge: -
Available brands
Cortic-DS 1% DPMQ: $19.01 Max safety net: $7.70 General Patient Charge: $7.70

HYDROCORTISONE ACETATE (11710H)

hydrocortisone acetate 1% cream, 30 g
11710H
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
No restrictions
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
Pharmacy Action Hydrocortisone Cream 1% DPMQ: $19.01 Max safety net: $7.70 General Patient Charge: $7.70
Trust HydroCortic Cream DPMQ: $19.01 Max safety net: $7.70 General Patient Charge: $7.70

HYDROCORTISONE ACETATE (2441L)

hydrocortisone acetate 1% eye ointment, 5 g
2441L
Body System:
Manner of administration:Application To The Eye
General Schedule
No restrictions
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: $19.27 Max safety net: $20.75 General Patient Charge: $23.54
Available brands
Hycor

HYDROCORTISONE ACETATE (2881P)

hydrocortisone acetate 1% cream, 50 g
2881P
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: $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

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: $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

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

HYDROCORTISONE ACETATE (5114E)

hydrocortisone acetate 1% ointment, 50 g
5114E
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

HYDROCORTISONE ACETATE (5516H)

hydrocortisone acetate 1% eye ointment, 5 g
5516H
Body System:
Manner of administration:Application To The Eye
General Schedule
No restrictions
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: $19.27 Max safety net: $20.75 General Patient Charge: $23.54
Available brands
Hycor