Limited Use Note(s)

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BUDESONIDE & FORMOTEROL FUMARATE DIHYDRATE & GLYCOPYRRONIUM182mcg & 5.8mcg & 8.2mcg/Act Metered Dose Inh-120 Dose Pk
Reason For Use CodeClinical Criteria
638For the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema and to reduce exacerbations of COPD in patients with a history of exacerbations in patients who require a combination of an inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and a long-acting beta2-adrenergic agonist (LABA).
LU Authorization Period: Indefinite.