Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
formoterol OR formoterol in combination with budesonide

Criteria Approval Period
Diagnosis of asthma
PLUS
inadequate response on optimal dose of inhaled corticosteroid.		 Indefinite

Practitioner Exemptions

  • Allergists
  • Respirologists

Special Notes

  • None

Online Forms (PDF)
Click on the link to complete a special authority request form.