Limited coverage criteria – indacaterol-mometasone furoate

Last updated on March 18, 2025

Special Authority requests can now be submitted online. It's simple and quick!

Generic name		indacaterol-mometasone furoate
Strength		Form
150 mcg indacaterol - 80 mcg mometasone furoate 150 mcg indacaterol - 160 mcg mometasone furoate 150 mcg indacaterol - 320 mcg mometasone furoate		powder hard capsules for inhalation

Special Authority criteria	Approval period
Diagnosis of asthma AND Inadequate response on optimal dose of an inhaled corticosteroid	Indefinite

Special Authority criteria

Approval period

Diagnosis of asthma

AND

Inadequate response on optimal dose of an inhaled corticosteroid

Indefinite

Practitioner exemptions

Practitioners in the following specialties are not required to submit a Special Authority request for coverage:

Respirologists
Allergists

Special notes

None

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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Limited coverage criteria – indacaterol-mometasone furoate

Generic name

Strength

Form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)