BUDESONIDE + FORMOTEROL

BUDESONIDE + FORMOTEROL (11273H)

budesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
11273H
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7970)

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: $37.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DuoResp Spiromax

BUDESONIDE + FORMOTEROL (11301T)

budesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 2 x 60 actuations
11301T
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7979)

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: 2 # of repeats: 5 DPMQ: $61.25 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DuoResp Spiromax

BUDESONIDE + FORMOTEROL (12029D)

budesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
12029D
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10464)

Indication: Mild 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: 2 DPMQ: $37.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DuoResp Spiromax

BUDESONIDE + FORMOTEROL (12093L)

budesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
12093L
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 10538)

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: $37.80 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bufomix EASYHALER 200/6
DuoResp Spiromax
Rilast TURBUHALER 200/6
Symbicort Turbuhaler 200/6
*Additional charge for this brand is $4.00
 DPMQ: $41.80 Max safety net: $25.00 General Patient Charge: $29.00

BUDESONIDE + FORMOTEROL (13258T)

budesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations
13258T
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7979)

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: 2 Max qty units: 2 # of repeats: 5 DPMQ: $61.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bufomix Easyhaler 400/12
DuoResp Spiromax
Rilast TURBUHALER 400/12
Symbicort TURBUHALER 400/12
*Additional charge for this brand is $4.00
 DPMQ: $65.26 Max safety net: $25.00 General Patient Charge: $29.00

BUDESONIDE + FORMOTEROL (14365C)

budesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
14365C
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15577)

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: $61.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bufomix EASYHALER 200/6
DuoResp Spiromax
Rilast TURBUHALER 200/6
Symbicort Turbuhaler 200/6
*Additional charge for this brand is $8.00
 DPMQ: $69.82 Max safety net: $25.00 General Patient Charge: $33.00

BUDESONIDE + FORMOTEROL (14398T)

budesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 60 actuations
14398T
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15617)

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
Max qty packs: 4 Max qty units: 4 # of repeats: 5 DPMQ: $108.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Bufomix Easyhaler 400/12
DuoResp Spiromax
Rilast TURBUHALER 400/12
Symbicort TURBUHALER 400/12
*Additional charge for this brand is $8.12
 DPMQ: $116.84 Max safety net: $25.00 General Patient Charge: $33.12

BUDESONIDE + FORMOTEROL (14434Q)

budesonide 200 microgram/actuation + formoterol fumarate dihydrate 6 microgram/actuation powder for inhalation, 120 actuations
14434Q
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15680)

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: $61.82 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DuoResp Spiromax

BUDESONIDE + FORMOTEROL (14435R)

budesonide 400 microgram/actuation + formoterol fumarate dihydrate 12 microgram/actuation powder for inhalation, 2 x 60 actuations
14435R
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15617)

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
Max qty packs: 2 Max qty units: 4 # of repeats: 5 DPMQ: $108.72 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
DuoResp Spiromax