Product Details
Ventolin
Salbutamol5 mg/mL
Inhalation Solution
10-mL Pack
DIN/PIN/NPN
02213486
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
1998-04-03
Unit Price
2.9400
Amount MOH Pays
2.9400
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AC02
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| Note: For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler. | ||
| 256 | Indefinite | Patients who have a tracheostomy; |
| 257 | Indefinite | Patients with cystic fibrosis in whom nebulizer therapy is indicated; |
| 258 | Indefinite | Patients with severe mental or physical disabilities; |
| 259 | Indefinite | Patients who have previously used nebulizer therapy within the last 12-month period. |