PTC 120808

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Products Found: 28

MFR

Review Status/
Past Decision(s)

ACLIDINIUM BROMIDE
TUDORZA GENUAIR
400 MCG / DOSE
INH  MIP
0.8850
N/A
DOSE
NO

REGULAR BENEFIT

ACLIDINIUM BROMIDE/ FORMOTEROL FUMARATE DIHYDRATE
DUAKLIR GENUAIR
400 MCG / DOSE * 12 MCG / DOSE
INH  MIP
1.0000
N/A
DOSE
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

ATROPINE SULFATE
ATROPINE INJECTION BP
0.4 MG / ML
INJ 
N/A
N/A
ML
NO

UNDER REVIEW *

ATROPINE SULFATE
ATROPINE SULFATE
0.4 MG / ML
INJ 
2.2880
N/A
ML
NO

REGULAR BENEFIT

 

ATROPINE SULFATE
ATROPINE INJECTION BP
0.6 MG / ML
INJ 
N/A
N/A
ML
NO

UNDER REVIEW *

ATROPINE SULFATE
ATROPINE SULFATE
0.6 MG / ML
INJ 
2.4880
N/A
ML
NO

REGULAR BENEFIT

 

02391619
DICYCLOMINE HCL
JAMP-DICYCLOMINE HCL
10 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02366088
DICYCLOMINE HCL
JAMP-DICYCLOMINE HCL
20 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

GLYCOPYRROLATE
GLYCOPYRROLATE
0.2 MG / ML
INJ 
3.9780
N/A
ML
NO

REGULAR BENEFIT

 

HYOSCINE BUTYLBROMIDE
BUSCOPAN
10 MG
ORL  TAB
0.3368
N/A
TAB
NO

REGULAR BENEFIT

 

HYOSCINE BUTYLBROMIDE
BUSCOPAN
20 MG / ML
INJ 
4.5860
N/A
ML
NO

REGULAR BENEFIT

 

INDACATEROL MALEATE/ GLYCOPYRRONIUM BROMIDE
ULTIBRO BREEZHALER
110 MCG * 50 MCG
INH  CAP
2.6150
N/A
CAP
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

IPRATROPIUM BROMIDE
PMS-IPRATROPIUM
0.03 %
NAS  SPR
0.8693
N/A
ML
NO

REGULAR BENEFIT

 

IPRATROPIUM BROMIDE
PMS-IPRATROPIUM
125 MCG / ML
INH  UDSOL
1.1505
N/A
ML
NO

SPECIAL AUTHORIZATION

IPRATROPIUM BROMIDE
ATROVENT HFA
20 MCG / DOSE
INH  AEM
0.1013
N/A
DOSE
NO

REGULAR BENEFIT

 

IPRATROPIUM BROMIDE
APO-IPRAVENT
250 MCG / ML
INH  SOL
0.3155
0.3155
ML
YES

REGULAR BENEFIT

 

IPRATROPIUM BROMIDE
PMS-IPRATROPIUM (1ML)
250 MCG / ML
INH  UDSOL
0.6590
0.6590
ML
YES

SPECIAL AUTHORIZATION

IPRATROPIUM BROMIDE
PMS-IPRATROPIUM (2ML)
250 MCG / ML
INH  UDSOL
0.6590
0.6590
ML
YES

SPECIAL AUTHORIZATION

IPRATROPIUM BROMIDE
PMS-IPRATROPIUM
250 MCG / ML
INH  SOL
0.3155
0.3155
ML
YES

REGULAR BENEFIT

IPRATROPIUM BROMIDE
TEVA-IPRATROPIUM STERINEBS
250 MCG / ML
INH  UDSOL
0.6590
0.6590
ML
YES

SPECIAL AUTHORIZATION

02419106
IPRATROPIUM BROMIDE/ SALBUTAMOL
COMBIVENT RESPIMAT
20 MCG / DOSE * 100 MCG / DOSE
INH  SOL
N/A
N/A
DOSE
NO

NOT A BENEFIT *

IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE
COMBIVENT UDV
0.2 MG / ML * 1 MG / ML
INH  SOL
0.6452
0.5318
ML
YES

REGULAR BENEFIT

 

IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE
TEVA-COMBO STERINEBS
0.2 MG / ML * 1 MG / ML
INH  SOL
0.5318
0.5318
ML
YES

REGULAR BENEFIT

TIOTROPIUM BROMIDE MONOHYDRATE
SPIRIVA
18 MCG
INH  CAP
1.8027
N/A
CAP
NO

REGULAR BENEFIT

 

TIOTROPIUM BROMIDE MONOHYDRATE
SPIRIVA RESPIMAT
2.5 MCG / DOSE
INH  SOL
0.9013
N/A
DOSE
NO

REGULAR BENEFIT

TIOTROPIUM BROMIDE MONOHYDRATE/ OLODATEROL HYDROCHLORIDE
INSPIOLTO RESPIMAT
2.5 MCG / DOSE * 2.5 MCG / DOSE
INH  SOL
1.0576
N/A
DOSE
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

UMECLIDINIUM BROMIDE
INCRUSE ELLIPTA
62.5 MCG / DOSE
INH  MIP
1.6667
N/A
DOSE
NO

REGULAR BENEFIT

UMECLIDINIUM BROMIDE/ VILANTEROL TRIFENATATE
ANORO ELLIPTA
62.5 MCG / DOSE * 25 MCG / DOSE
INH  MIP
2.8130
N/A
DOSE
NO

STEP THERAPY/ SPECIAL AUTHORIZATION


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