MOMETASONE

mometasone furoate 0.1% lotion, 30 mL

MOMETASONE (10826T)

mometasone furoate 0.1% lotion, 30 mL
10826T
Body System:
Manner of administration:Application
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 6246)

Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $29.49 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Novasone
Zatamil
Elocon
*Additional charge for this brand is $16.50
 DPMQ: $45.99 Max safety net: $25.00 General Patient Charge: $41.50