Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10804PMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	5	5	5	$39.62	$31.60	$31.60
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $22.50B	5	5	5	$62.12	$31.60	$54.10

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10805QMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	4	4	5	$34.39	$31.60	$31.60
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $18.00B	4	4	5	$52.39	$31.60	$49.60

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10819KMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	2	2	5	$23.93	$25.38	$28.83
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $9.00B	2	2	5	$32.93	$25.38	$37.83

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

Authority Required (STREAMLINED)

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
10826TMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	3	3	5	$29.16	$30.61	$31.60
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $13.50B	3	3	5	$42.66	$30.61	$45.10

Source	General Schedule
Body System	DERMATOLOGICALS > CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS > CORTICOSTEROIDS, PLAIN

Note

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
8043HMPNP	MOMETASONE mometasone furoate 0.1% lotion, 30 mL (PI, CMI)	1	1	0	$18.69	$20.14	$23.59
	Available brands
	Novasonea
	Zatamila
	Elocona * Additional charge for this brand is $4.50B	1	1	0	$23.19	$20.14	$28.09