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 |
Practitioner Exemptions
- Respirologists and allergists are not required to submit a Special Authority request form for coverage.
Special Notes
- None
Special Authority Request Form(s)