Limited Use Note(s)

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INDACATEROL ACETATE & GLYCOPYRRONIUM BROMIDE & MOMETASONE FUROATE150mcg & 50mcg & 160mcg Inh Pd-Cap
Reason For Use CodeClinical Criteria
627For the treatment of asthma in adult patients inadequately controlled with a maintenance combination of a long-acting beta-2 agonist (LABA) and a medium or high dose of an inhaled corticosteroid (ICS), who experienced one or more asthma exacerbations in the previous 12 months.
LU Authorization Period: Indefinite.