NEBULIZER (PEDS OR ADULT) + 1 MONTH SUPPLY OF ALBUTEROL OR SODIUM CHLORIDE $50
Pulmonary Medications
| Drug Name |
Covered |
Not Covered |
| Advair Diskus |
$35 |
$35 |
| Advair HFA |
$35 |
$35 |
| Airsupra |
$0 |
- |
| Alvesco |
$60 |
- |
| Anoro Ellipta |
$35 |
$35 |
| Arnuity Ellipta |
$35 |
$35 |
| Asmanex |
$15 |
- |
| Bevespi |
$35 |
- |
| Breo Ellipta |
$35 |
$35 |
| Breztri |
$0 |
- |
| Clemastine Syrup |
$0 |
- |
| Dulera |
$15 |
- |
| Dupixent |
$0 |
- |
| Esbriet |
$5 |
- |
| Incruse Ellipta |
$35 |
$35 |
| Pulmozyme |
$30 |
- |
| Serevent Diskus |
$35 |
$35 |
| Spiriva |
$35 |
$35 |
| Stiolto Ellipta |
$35 |
- |
| Striverdi |
$35 |
$35 |
| Symbicort |
$35 |
- |
| Trelegy Ellipta |
$0 |
- |
| Tudorza Pressair |
$0 |
- |
| Ventolin HFA (Brand) |
$35 |
$35 |
Allergy Copay Support
| Dupixent |
$0 |
- |
| Ebglyss |
$5 |
$25 |
| Epinephrine |
$0 |
- |
| Opzelura |
$0 |
$35 |
| Xhance |
$0 |
- |
| Zoryve |
$0 |
- |