FLUTICASONE PROPIONATE + SALMETEROL

FLUTICASONE PROPIONATE + SALMETEROL (14311F)

fluticasone propionate 250 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations
14311F
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

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
Max qty packs: 2 Max qty units: 2 # of repeats: 5 DPMQ: $92.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Evocair MDI
Fluticasone + Salmeterol Cipla 250/25
Pavtide
SalplusF Inhaler 250/25
Seretide MDI 250/25
*Additional charge for this brand is $8.00
 DPMQ: $100.62 Max safety net: $25.00 General Patient Charge: $33.00

FLUTICASONE PROPIONATE + SALMETEROL (14449L)

fluticasone propionate 250 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations
14449L
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15693)

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
Fluticasone Salmeterol Ciphaler 250/50
PAVTIDE ACCUHALER 250/50
Salflumix Easyhaler 250/50
SalplusF DPI 250/50
Seretide Accuhaler 250/50
*Additional charge for this brand is $10.00
 DPMQ: $82.02 Max safety net: $25.00 General Patient Charge: $35.00

FLUTICASONE PROPIONATE + SALMETEROL (14450M)

fluticasone propionate 500 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations
14450M
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15714)

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: 2 # of repeats: 5 DPMQ: $92.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Fluticasone Salmeterol Ciphaler 500/50
PAVTIDE ACCUHALER 500/50
Salflumix Easyhaler 500/50
SalplusF DPI 500/50
Seretide Accuhaler 500/50
*Additional charge for this brand is $8.00
 DPMQ: $100.62 Max safety net: $25.00 General Patient Charge: $33.00

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 (8431R)

fluticasone propionate 250 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations
8431R
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15138)

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
Fluticasone Salmeterol Ciphaler 250/50
PAVTIDE ACCUHALER 250/50
Salflumix Easyhaler 250/50
SalplusF DPI 250/50
Seretide Accuhaler 250/50
*Additional charge for this brand is $5.00
 DPMQ: $47.90 Max safety net: $25.00 General Patient Charge: $30.00

FLUTICASONE PROPIONATE + SALMETEROL (8432T)

fluticasone propionate 500 microgram/actuation + salmeterol 50 microgram/actuation powder for inhalation, 60 actuations
8432T
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 15118)

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
Available brands
Fluticasone Salmeterol Ciphaler 500/50
PAVTIDE ACCUHALER 500/50
Salflumix Easyhaler 500/50
SalplusF DPI 500/50
Seretide Accuhaler 500/50
*Additional charge for this brand is $4.00
 DPMQ: $57.20 Max safety net: $25.00 General Patient Charge: $29.00

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

FLUTICASONE PROPIONATE + SALMETEROL (8519J)

fluticasone propionate 250 microgram/actuation + salmeterol 25 microgram/actuation inhalation, 120 actuations
8519J
Body System:
Manner of administration:Inhalation By Mouth
General Schedule
Authority Required (STREAMLINED)

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
Available brands
Evocair MDI
Fluticasone + Salmeterol Cipla 250/25
Pavtide
SalplusF Inhaler 250/25
Seretide MDI 250/25
*Additional charge for this brand is $4.00
 DPMQ: $57.20 Max safety net: $25.00 General Patient Charge: $29.00