Limited Use Note(s)

FORMOTEROL FUMARATE DIHYDRATE12mcg/Metered Dose Pd Inh-60 Dose Pk

Reason For Use Code	Clinical Criteria
132	For the treatment of asthma in patients who are using optimum anti-inflammatory treatment and are still experiencing breakthrough symptoms.
	NOTE: This drug is not for relief of acute symptoms.
	LU Authorization Period: Indefinite