Product Details
PMS-FluticasonePropionateSalmeterol DPI
Salmeterol Xinafoate + Fluticasone Propionate50 mcg + 250 mcg
Powder for Inhalation
60-Dose Pack
DIN/PIN/NPN
02494515
Manufacturer
Pharmascience Inc.
Formulary Listing Date
2020-04-30
Unit Price
50.7600
Amount MOH Pays
50.7600
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AK06
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02495600 | Wixela Inhub | 50.7600 | 50.7600 |
| 02494515 | PMS-FluticasonePropionateSalmeterol DPI | 50.7600 | 50.7600 |
| 02240836 | Advair Diskus | 128.4200 | 50.7600 |
LU 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. |