FORMOTEROL

formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations
Manner of administration:Inhalation By Mouth
General Schedule
Restricted Benefit

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: $46.78 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
General Schedule
Restricted Benefit

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: $30.28 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Oxis Turbuhaler