Product Details
Breo Ellipta
Fluticasone Furoate + Vilanterol200 mcg + 25 mcg
Powder for Inhalation
30-Dose Blister Pack
DIN/PIN/NPN
02444186
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
2016-08-30
Unit Price
162.4700
Amount MOH Pays
162.4700
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AK10
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 330 | Indefinite | For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms. |