Limited Coverage Drugs - Formoterol/Mometasone

Generic Name / Strength / Form

formoterol OR formoterol in combination with mometasone

Special Authority Criteria

Approval Period

Diagnosis of asthma
PLUS
inadequate response on optimal dose of inhaled corticosteroid.
Indefinite

Practitioner Exemptions

  • Allergists
  • Respirologists

Special Notes

  • None

Special Authority Request Form(s)