IMIQUIMOD

IMIQUIMOD (10106X)

imiquimod 5% cream, 2 x 2 g
10106X
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Solar keratosis
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
Aldara Pump DPMQ: $95.72 Max safety net: $7.70 General Patient Charge: $7.70

IMIQUIMOD (2546B)

imiquimod 5% cream, 12 x 250 mg sachets
2546B
Body System:
Manner of administration:Application
General Schedule
Authority Required

Restriction

Indication: Superficial basal cell carcinoma
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: $87.63 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Imiquimod
Aldara
*Additional charge for this brand is $3.20
 DPMQ: $90.83 Max safety net: $25.00 General Patient Charge: $28.20

IMIQUIMOD (2637T)

imiquimod 5% cream, 2 x 2 g
2637T
Body System:
Manner of administration:Application
General Schedule
Authority Required

Restriction

Indication: Superficial basal cell carcinoma
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
Aldara Pump
*Additional charge for this brand is $8.09
 DPMQ: $95.72 Max safety net: $25.00 General Patient Charge: $33.09

IMIQUIMOD (4134N)

imiquimod 5% cream, 12 x 250 mg sachets
4134N
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Solar keratosis
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
Aldara DPMQ: $90.83 Max safety net: $7.70 General Patient Charge: $7.70
APO-Imiquimod DPMQ: $87.63 Max safety net: $7.70 General Patient Charge: $7.70

IMIQUIMOD (4559Y)

imiquimod 5% cream, 12 x 250 mg sachets
4559Y
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
Authority Required

Restriction

Indication: Superficial basal cell carcinoma
Treatment phase: Primary treatment
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
Aldara DPMQ: $90.83 Max safety net: $7.70 General Patient Charge: $7.70
APO-Imiquimod DPMQ: $87.63 Max safety net: $7.70 General Patient Charge: $7.70