Limited coverage drugs – mometasone furoate in combination with formoterol
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|
Generic name |
mometasone furoate-formoterol |
|---|---|
|
Strength |
mometasone furoate 100 mcg or 200 mcg/formoterol 5 mcg |
|
Form |
suspension 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
