Limited Coverage Drugs - formoterol

Generic Name

formoterol

Strength

6 mcg or 12 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)