BETAMETHASONE DIPROPIONATE

BETAMETHASONE DIPROPIONATE (1119X)

betamethasone (as dipropionate) 0.05% ointment, 15 g
1119X
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: 1 Max qty units: 1 # of repeats: 1 DPMQ: $18.25 Max safety net: $19.79 General Patient Charge: $22.58
Available brands
DIPROVANT
Eleuphrat
Diprosone
*Additional charge for this brand is $2.28
 DPMQ: $20.53 Max safety net: $19.79 General Patient Charge: $24.86