Respiratory Agents, Miscellaneous

Showing 1–12 of 48 results

NAME	ALSO KNOW AS	DRUG CATEGORY	FORMULARY CATEGORY	WHAT WE COVER	COST SHARE
Omalizumab Sosy 150Mg/Ml (Generic)	Xolair Sosy 150 Mg/Ml (Brand)	Respiratory Agents, Miscellaneous	MA	Administered in Medical Office	N/A
Omalizumab Sosy 75Mg/0.5Ml (Generic)	Xolair Sosy 75 Mg/0.5Ml (Brand)	Respiratory Agents, Miscellaneous	MA	Administered in Medical Office	N/A
Pulmicort Flexhaler Aepb 180 Mcg/Act (Brand)	Budesonide (Inhalation) Aepb 180Mcg/Act (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Pulmicort Flexhaler Aepb 90 Mcg/Act (Brand)	Budesonide (Inhalation) Aepb 90Mcg/Act (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Pulmicort Susp 0.25 Mg/2Ml (Brand)	Budesonide (Inhalation) Susp .25Mg/2Ml (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Pulmicort Susp 0.5 Mg/2Ml (Brand)	Budesonide (Inhalation) Susp .5Mg/2Ml (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Pulmicort Susp 1 Mg/2Ml (Brand)	Budesonide (Inhalation) Susp 1Mg/2Ml (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Qvar Redihaler Aerb 40 Mcg/Act (Brand)	Beclomethasone Dipropionate Hfa Aerb 40Mcg/Act (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Qvar Redihaler Aerb 80 Mcg/Act (Brand)	Beclomethasone Dipropionate Hfa Aerb 80Mcg/Act (Generic)	Respiratory Agents, Miscellaneous	3	Non-Formulary Brand	$68
Roflumilast Tabs 250 Mcg (Generic)	Daliresp Tabs 250 Mcg (Brand)	Respiratory Agents, Miscellaneous	1	Generic	$14
Roflumilast Tabs 500 Mcg (Generic)	Daliresp Tabs 500 Mcg (Brand)	Respiratory Agents, Miscellaneous	1	Generic	$14
Symbicort Aero 160-4.5 Mcg/Act (Brand)	Budesonide-Formoterol Fumarate Dihydrate Aero (Generic)	Respiratory Agents, Miscellaneous	2	Formulary Brand	$38
Symbicort Aero 80-4.5 Mcg/Act (Brand)	Budesonide-Formoterol Fumarate Dihydrate Aero (Generic)	Respiratory Agents, Miscellaneous	2	Formulary Brand	$38

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