FLUTICASONE PROPIONATE + SALMETEROL

FLUTICASONE PROPIONATE + SALMETEROL (14413N)

fluticasone propionate 100 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations
14413N
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15604)

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: $74.74 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
PAVTIDE ACCUHALER 100/50
Seretide Accuhaler 100/50
*Additional charge for this brand is $8.00
 DPMQ: $82.74 Max safety net: $25.00 General Patient Charge: $33.00

FLUTICASONE PROPIONATE + SALMETEROL (8430Q)

fluticasone propionate 100 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations
8430Q
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4930)

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: $44.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
PAVTIDE ACCUHALER 100/50
Seretide Accuhaler 100/50
*Additional charge for this brand is $4.00
 DPMQ: $48.26 Max safety net: $25.00 General Patient Charge: $29.00