FORMOTEROL
Manner of administration:Inhalation By Mouth
Restriction
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: 120 | # of repeats: 5 | DPMQ: $47.32 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Foradile | |||||
formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
Restriction
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: $46.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Oxis Turbuhaler | |||||
formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
Restriction
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: $35.64 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Oxis Turbuhaler | |||||
Manner of administration:Inhalation By Mouth
Restriction
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: 60 | # of repeats: 5 | DPMQ: $30.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Foradile | |||||
formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
Restriction
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: $25.00 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Oxis Turbuhaler | |||||
formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
Restriction
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: $30.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Oxis Turbuhaler | |||||