Limited Coverage Drugs – budesonide in combination with formoterol

Generic Name	budesonide-formoterol
Strength	budesonide 100 mcg or 200 mcg/formoterol 6 mcg
Form	dry powder for oral inhalation

Special Authority Criteria	Approval Period
Diagnosis of asthma AND inadequate response on optimal dose of inhaled corticosteroid.	Indefinite

Special Authority Criteria

Approval Period

Diagnosis of asthma

AND

inadequate response on optimal dose of inhaled corticosteroid.

Indefinite

Practitioner Exemptions

Respirologists and allergists are not required to submit a Special Authority request form for coverage.