Product Details
Ipratropium Bromide and Salbutamol Sulph
Ipratropium Bromide + Salbutamol500 mcg + 2.5 mg/2.5 mL
Inhalation Solution
2.5-mL Ampoule Pack
DIN/PIN/NPN
02483394
Manufacturer
MDA Inc.
Formulary Listing Date
2019-12-20
Unit Price
0.8066
Amount MOH Pays
0.8066
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03AL02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02272695 | Teva-Combo Sterinebs | 0.8066 | 0.8066 |
| 02483394 | Ipratropium Bromide and Salbutamol Sulph | 0.8066 | 0.8066 |
| 02231675 | Combivent UDV | NA | NA |
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. | ||
| 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. |