Product Details
Breztri Aerosphere
Budesonide + Glycopyrronium (Glycopyrronium Bromide) + Formoterol Fumarate Dihydrate160 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
NOLU 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). |