UMECLIDINIUM

umeclidinium 62.5 microgram powder for inhalation, 30 actuations
Manner of administration:Inhalation By Mouth
General Schedule
Restricted Benefit

Restriction

Indication: Chronic obstructive pulmonary disease (COPD)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $59.70 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Incruse Ellipta
umeclidinium 62.5 microgram powder for inhalation, 30 actuations
Manner of administration:Inhalation By Mouth
General Schedule
Restricted Benefit

Restriction

Indication: Chronic obstructive pulmonary disease (COPD)
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $105.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Incruse Ellipta