Limited coverage criteria – formoterol

Last updated on March 4, 2025

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Generic name	formoterol
Strength & form	6 mcg or 12 mcg dry powder for oral inhalation

Special Authority criteria	Approval period
Diagnosis of asthma AND Inadequate response on optimal dose of inhaled corticosteroid	Indefinite

Practitioner exemptions

Respirologists and allergists are not required to submit a Special Authority request form for coverage

Special notes

None

Special Authority request form

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HLTH 5328 - General form for asthma (PDF, 656KB)

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Limited coverage criteria – formoterol

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form