HYDROCORTISONE

HYDROCORTISONE (13863P)

hydrocortisone 4 mg tablet, 50
13863P
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 100 # of repeats: 4 DPMQ: $42.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydrocortisone Viatris 4
Hysone 4
*Additional charge for this brand is $6.00
 DPMQ: $48.72 Max safety net: $25.00 General Patient Charge: $31.00

HYDROCORTISONE (1499X)

hydrocortisone 4 mg tablet, 50
1499X
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: For prescribing by certain health practitioners
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 50 # of repeats: 4 DPMQ: $28.25 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydrocortisone Viatris 4
Hysone 4
*Additional charge for this brand is $3.00
 DPMQ: $31.25 Max safety net: $25.00 General Patient Charge: $28.00