INDACATEROL + GLYCOPYRRONIUM + MOMETASONE
indacaterol 114 microgram + glycopyrronium 46 microgram + mometasone furoate 136 microgram
powder for inhalation, 30 capsules
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 12603)
Indication: Severe 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: 30 | # of repeats: 5 | DPMQ: $89.38 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Enerzair Breezhaler | |||||
indacaterol 114 microgram + glycopyrronium 46 microgram + mometasone furoate 68 microgram
powder for inhalation, 30 capsules
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 12603)
Indication: Severe 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: 30 | # of repeats: 5 | DPMQ: $73.55 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Enerzair Breezhaler | |||||
indacaterol 114 microgram + glycopyrronium 46 microgram + mometasone furoate 136 microgram
powder for inhalation, 30 capsules
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15601)
Indication: Severe 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: 60 | # of repeats: 5 | DPMQ: $167.52 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Enerzair Breezhaler | |||||
indacaterol 114 microgram + glycopyrronium 46 microgram + mometasone furoate 68 microgram
powder for inhalation, 30 capsules
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15601)
Indication: Severe 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: 60 | # of repeats: 5 | DPMQ: $134.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Enerzair Breezhaler | |||||