BUDESONIDE + FORMOTEROL

BUDESONIDE + FORMOTEROL (12101X)

budesonide 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
12101X
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10538)

Indication: Asthma
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: $41.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Symbicort Turbuhaler 100/6

BUDESONIDE + FORMOTEROL (14437W)

budesonide 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
14437W
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15577)

Indication: Asthma
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: $68.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Symbicort Turbuhaler 100/6

BUDESONIDE + FORMOTEROL (14440B)

budesonide 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
14440B
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15755)

Indication: Asthma
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: $68.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Symbicort Turbuhaler 100/6

BUDESONIDE + FORMOTEROL (8796Y)

budesonide 100 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
8796Y
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4380)

Indication: Asthma
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: $41.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Symbicort Turbuhaler 100/6