Interchangeable Grouping
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12:00 AUTONOMIC AGENTS
12:12:00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS
LU Criteria Text
SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE
50/100mcg Inh-60 Dose Pk
Interchangeables found: 3
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02240835
Advair Diskus
107.2700
42.4050
02494507
PMS-FluticasonePropionateSalmeterol DPI
42.4050
42.4050
02495597
Wixela Inhub
42.4050
42.4050
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