MOMETASONE

mometasone furoate 0.1% cream, 15 g

MOMETASONE (1913Q)

mometasone furoate 0.1% cream, 15 g
1913Q
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: 0 DPMQ: $17.55 Max safety net: $19.03 General Patient Charge: $21.82
Available brands
GLENMARK MOMETASONE Alcohol Free
Novasone
Elocon Alcohol Free
*Additional charge for this brand is $3.53
 DPMQ: $21.08 Max safety net: $19.03 General Patient Charge: $25.35