Limited coverage drugs – mometasone furoate in combination with formoterol

Last updated on August 23, 2024

Generic name

mometasone furoate-formoterol

Strength

mometasone furoate 100 mcg or 200 mcg/formoterol 5 mcg

Form

suspension 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(s)