FLUTICASONE PROPIONATE + SALMETEROL

FLUTICASONE PROPIONATE + SALMETEROL (14544L)

fluticasone propionate 125 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations
14544L
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: $72.02 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Evocair MDI
Fluticasone + Salmeterol Cipla 125/25
Pavtide
SalplusF Inhaler 125/25
Seretide MDI 125/25
*Additional charge for this brand is $10.00
 DPMQ: $82.02 Max safety net: $25.00 General Patient Charge: $35.00

FLUTICASONE PROPIONATE + SALMETEROL (8518H)

fluticasone propionate 125 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations
8518H
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: $42.90 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Evocair MDI
Fluticasone + Salmeterol Cipla 125/25
Pavtide
SalplusF Inhaler 125/25
Seretide MDI 125/25
*Additional charge for this brand is $5.00
 DPMQ: $47.90 Max safety net: $25.00 General Patient Charge: $30.00