Product Details
SereVent Diskus
Salmeterol Xinafoate50 mcg
Powder for Inhalation
60-Dose Pack
DIN/PIN/NPN
02231129
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
1998-12-31
Unit Price
75.2000
Amount MOH Pays
75.2000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AC12
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 132 | Indefinite | For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms. Note: This drug is not for relief of acute symptoms. |
| 391 | Indefinite | For patients with moderate to severe COPD with persistent respiratory symptoms despite an adequate trial of, or an intolerance to, a regularly scheduled short-acting bronchodilator AND a long-acting anticholinergic. |