Product Details
Advair Diskus
Salmeterol Xinafoate + Fluticasone Propionate50 mcg + 100 mcg
Powder for Inhalation
60-Dose Pack
DIN/PIN/NPN
02240835
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
2001-10-11
Unit Price
107.2700
Amount MOH Pays
42.4050
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 |
|---|---|---|---|
| 02495597 | Wixela Inhub | 42.4050 | 42.4050 |
| 02494507 | PMS-FluticasonePropionateSalmeterol DPI | 42.4050 | 42.4050 |
| 02240835 | Advair Diskus | 107.2700 | 42.4050 |
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. |