BECLOMETASONE + FORMOTEROL
beclometasone dipropionate 100 microgram/actuation + formoterol fumarate dihydrate
6 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15469)
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: $37.80 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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beclometasone dipropionate 200 microgram/actuation + formoterol fumarate dihydrate
6 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 11057)
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: $47.98 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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beclometasone dipropionate 100 microgram/actuation + formoterol fumarate dihydrate
6 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15599)
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: $61.82 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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beclometasone dipropionate 200 microgram/actuation + formoterol fumarate dihydrate
6 microgram/actuation inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15656)
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: $82.18 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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