MUPIROCIN

MUPIROCIN (11822F)

mupirocin 2% ointment, 5 g
11822F
Body System:
Manner of administration:Nasal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6647)

Indication: Staphylococcus aureus infection
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: $27.31 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Mupirocin Nasal (Medsurge)

MUPIROCIN (4348W)

mupirocin 2% cream, 15 g
4348W
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
Restricted Benefit

Restriction

Indication: Secondarily infected traumatic skin lesions
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: - Max safety net: - General Patient Charge: -
Available brands
Bactroban DPMQ: $26.28 Max safety net: $7.70 General Patient Charge: $7.70
SUPIROCIN DPMQ: $26.28 Max safety net: $7.70 General Patient Charge: $7.70

MUPIROCIN (4350Y)

mupirocin 2% ointment, 15 g
4350Y
Body System:
Manner of administration:Application
Repatriation Pharmaceutical Benefits
No restrictions
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: - Max safety net: - General Patient Charge: -
Available brands
Bactroban DPMQ: $26.28 Max safety net: $7.70 General Patient Charge: $7.70
APO-Mupirocin DPMQ: $23.21 Max safety net: $7.70 General Patient Charge: $7.70
Medicianz Mupirocin Ointment DPMQ: $22.41 Max safety net: $7.70 General Patient Charge: $7.70
MUPIROCIN-WGR DPMQ: $22.41 Max safety net: $7.70 General Patient Charge: $7.70

MUPIROCIN (9440W)

mupirocin 2% ointment, 3 g
9440W
Body System:
Manner of administration:Nasal
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6647)

Indication: Staphylococcus aureus infection
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: $23.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bactroban