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: $42.42 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydrocortisone Viatris 4
Hysone 4
*Additional charge for this brand is $5.82
 DPMQ: $48.24 Max safety net: $25.00 General Patient Charge: $30.82

HYDROCORTISONE (14476X)

hydrocortisone 20 mg tablet, 60
14476X
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: 120 # of repeats: 4 DPMQ: $54.42 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydrocortisone Viatris 20
Hysone 20
*Additional charge for this brand is $5.82
 DPMQ: $60.24 Max safety net: $25.00 General Patient Charge: $30.82

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: $28.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydrocortisone Viatris 4
Hysone 4
*Additional charge for this brand is $2.91
 DPMQ: $31.30 Max safety net: $25.00 General Patient Charge: $27.91

HYDROCORTISONE (1500Y)

hydrocortisone 20 mg tablet, 60
1500Y
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: 60 # of repeats: 4 DPMQ: $34.39 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Hydrocortisone Viatris 20
Hysone 20
*Additional charge for this brand is $2.91
 DPMQ: $37.30 Max safety net: $25.00 General Patient Charge: $27.91