Product Details
PMS-Salbutamol
Salbutamol2 mg/mL
Inhalation Solution
2.5-mL Pack
DIN/PIN/NPN
02208237
Manufacturer
Pharmascience Inc.
Formulary Listing Date
1997-04-10
Unit Price
0.6750
Amount MOH Pays
0.6750
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AC02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02213427 | Ventolin Nebules P.F. | NA | NA |
| 02173360 | Teva-Salbutamol Sterinebs P.F. | 0.6871 | 0.6750 |
| 02208237 | PMS-Salbutamol | 0.6750 | 0.6750 |
LU 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. | ||
| 265 | Indefinite | Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have a tracheostomy; |
| 266 | Indefinite | Individuals must have a known hypersensitivity to the preservative in the bulk solution, and be patients with cystic fibrosis in whom nebulizer therapy is indicated; |
| 267 | Indefinite | Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have severe mental or physical disabilities; |
| 268 | Indefinite | Patients who have previously used nebulizer therapy within the last 12-month period. |