TRIAMCINOLONE

TRIAMCINOLONE (2117K)

triamcinolone acetonide 0.02% cream, 100 g
2117K
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: 2 Max qty units: 2 # of repeats: 0 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
Tricortone
Aristocort 0.02%
*Additional charge for this brand is $3.28
 DPMQ: $24.60 Max safety net: $22.80 General Patient Charge: $28.28

TRIAMCINOLONE (2118L)

triamcinolone acetonide 0.02% ointment, 100 g
2118L
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: 2 Max qty units: 2 # of repeats: 0 DPMQ: $21.32 Max safety net: $22.80 General Patient Charge: $25.00
Available brands
Tricortone
Aristocort 0.02%
*Additional charge for this brand is $3.28
 DPMQ: $24.60 Max safety net: $22.80 General Patient Charge: $28.28

TRIAMCINOLONE (2990J)

triamcinolone acetonide 10 mg/mL injection, 5 x 1 mL ampoules
2990J
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Alopecia areata

Restriction

Indication: Local intra-articular or peri-articular infiltration

Restriction

Indication: Granulomata

Restriction

Indication: Keloid

Restriction

Indication: Lichen planus hypertrophic

Restriction

Indication: Lichen simplex chronicus

Restriction

Indication: Chronic discoid lupus erythematosus

Restriction

Indication: Necrobiosis lipoidica

Restriction

Indication: 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: 5 # of repeats: 0 DPMQ: $29.95 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kenacort-A10

TRIAMCINOLONE (5233K)

triamcinolone acetonide 10 mg/mL injection, 5 x 1 mL ampoules
5233K
Body System:
Manner of administration:Injection
General Schedule
Restricted Benefit

Restriction

Indication: Local intra-articular or peri-articular infiltration

Restriction

Indication: Keloid

Restriction

Indication: Lichen planus hypertrophic
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 5 # of repeats: 0 DPMQ: $29.95 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Kenacort-A10