Clickable Table
| Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
|---|---|---|---|---|---|---|---|---|
| Fluticasone furoate/Umeclidinium/Vilanterol | Trelegy Ellipta (30) | 100/62.5/25 mcg | 1 pf qd | $470 | BC - SA / NIHB - Covered | E Respiratory | Long-acting beta-agonist/long acting muscarinic antagonist/Corticosteroid Combos | |
| Salbutamol | Ventolin (200) | 100 mcg | 4 pfs/d | $25 | BC / NIHB - Covered | E Respiratory |
Bronchodilators / Anti-cholingergics
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Fluticasone/Salmeterol | Advair Diskus (60) | 250/50 mcg | 1 pf bid | $180 | BC / NIHB - SA | E Respiratory | Long-acting beta-agonist/Corticosteroid Combos | |
| Ciclesonide | Alvesco (120) | 100 mcg, 200 mcg | 2 pf qd | $160 | BC / NIHB - Covered | E Respiratory | Adrenals | |
| Ipratropium | Atrovent (200) | 200 mcg | 1 pf qid | $35 | BC / NIHB - Covered | E Respiratory |
Bronchodilators / Anti-cholingergics
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Glycopyrronium/Indacaterol | Ultibro (30) | 50/110 mcg | 1 pf qd | $270 | BC / NIHB - Covered | E Respiratory |
Long-acting Anti-cholinergic/Long-acting Beta-agonist Combos
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Montelukast | Singulair | 10 mg | QD | $55 | BC - Restricted / NIHB - Covered | E Respiratory | Leukotriene Receptor Antagonist | |
| Beclomethasone | Qvar (200) | 100 mcg | 1 pf bid | $85 | BC / NIHB - Covered | E Respiratory |
Corticosteroids
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Tiotropium | Spiriva (30) | 18 mcg | 1 pf qd | $105 | BC / NIHB - Covered | E Respiratory |
Bronchodilators / Anti-cholingergics
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Budesonide/Formoterol | Symbicort (120) | 200/6 mcg | 1 pf qd | $180 | BC / NIHB - SA | E Respiratory | Long-acting beta-agonist/Corticosteroid Combos | |
| Glycopyrronium | Seebri (30) | 50 mcg | 1 pf qd | $195 | BC / NIHB - Covered | E Respiratory |
Bronchodilators / Anti-cholingergics
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Fluticasone/Salmeterol | Advair MDI (120) | 250/25 mcg | 1 pf bid | $290 | BC / NIHB - SA | E Respiratory | Long-acting beta-agonist/Corticosteroid Combos | |
| Budesonide | Pulmicort (200) | 200 mcg | 1 pf bid | $90 | BC / NIHB - Covered | E Respiratory |
Corticosteroids
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Fluticasone/Vilanterol | Breo Ellipta (30) | 100/25 mcg | 1 pf qd | $340 | BC / NIHB - SA | E Respiratory | Long-acting beta-agonist/Corticosteroid Combos | |
| Fluticasone | Flovent (120) | 250 mcg | 1 pf bid | $90 | BC / NIHB - Covered | E Respiratory |
Corticosteroids
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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| Fluticasone | Flovent (120) | 125 mcg | 1 pf bid | $55 | BC / NIHB - Covered | E Respiratory |
Corticosteroids
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
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