Product Details

Breztri Aerosphere

Budesonide + Glycopyrronium (Glycopyrronium Bromide) + Formoterol Fumarate Dihydrate
160 mcg + 7.2 mcg + 5 mcg/Actuation
Metered Dose Inhaler
120-Dose Pack

DIN/PIN/NPN

02518058

Manufacturer

AstraZeneca

Formulary Listing Date

2022-10-31  

Unit Price

127.0000

Amount MOH Pays

127.0000

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

R03AL11

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
638 Indefinite

For the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema and to reduce exacerbations of COPD in patients with a history of exacerbations in patients who require a combination of an inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and a long-acting beta2-adrenergic agonist (LABA).

 

EAP Criteria

NO

Product Monograph

View Monograph