CLOBETASOL

CLOBETASOL (10080M)

clobetasol propionate 0.05% shampoo, 125 mL
10080M
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17270)

Indication: Moderate to severe scalp psoriasis
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: $47.83 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Clobex

CLOBETASOL (14808J)

clobetasol propionate 0.05% ointment, 30 g
14808J
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: $21.64 Max safety net: $23.12 General Patient Charge: $25.00
Available brands
Xobet

CLOBETASOL (14832P)

clobetasol propionate 0.05% cream, 30 g
14832P
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: $21.64 Max safety net: $23.12 General Patient Charge: $25.00
Available brands
Xobet