Limited coverage drugs – mometasone

Last updated on October 6, 2022

Generic Name / Strength / Form

mometasone nasal spray

Criteria

Approval period

Diagnosis of allergic rhinitis
PLUS
person between ages three to eleven years.
Up to person's twelfth birthday.

Practitioner exemptions

  • No practitioner exemptions

Special notes

  • None

Special Authority request form(s)