GLUCOCORTICOIDS: INHALED | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ADVAIR 100-50 DISKUS fluticasone propion/salmeterol	00173069500 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR 250-50 DISKUS fluticasone propion/salmeterol	00173069600 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR 500-50 DISKUS fluticasone propion/salmeterol	00173069700 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR HFA 115-21 MCG INHALER fluticasone propion/salmeterol	00173071620 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR HFA 115-21 MCG INHALER fluticasone propion/salmeterol	00173071622 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR HFA 230-21 MCG INHALER fluticasone propion/salmeterol	00173071720 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR HFA 230-21 MCG INHALER fluticasone propion/salmeterol	00173071722 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN
ADVAIR HFA 45-21 MCG INHALER fluticasone propion/salmeterol	00173071520 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ADVAIR HFA 45-21 MCG INHALER fluticasone propion/salmeterol	00173071522 GLAXOSMITHKLINE	Yes	No	Medicaid CHIP CSHCN HTWPlus
ASMANEX TWISTHALER 110 MCG #30 mometasone furoate	78206011501 ORGANON LLC	Yes	No	Medicaid CHIP CSHCN