FLUTICASONE PROPIONATE + SALMETEROL
fluticasone propionate 250 microgram/actuation + salmeterol 25 microgram/actuation
inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 15715)
Indication: Asthma
Restriction (Streamlined authority code: 15548)
Indication: Chronic obstructive pulmonary disease (COPD)
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 2 | Max qty units: 2 | # of repeats: 5 | DPMQ: $92.62 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $100.62 | Max safety net: $25.00 | General Patient Charge: $33.00 | ||
fluticasone propionate 250 microgram/actuation + salmeterol 25 microgram/actuation
inhalation, 120 actuations
Manner of administration:Inhalation By Mouth
Restriction (Streamlined authority code: 4930)
Indication: Asthma
Restriction (Streamlined authority code: 10121)
Indication: Chronic obstructive pulmonary disease (COPD)
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: $53.20 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $57.20 | Max safety net: $25.00 | General Patient Charge: $29.00 | ||