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budesonide/formoterol 80/4.5 mcg and 160/4.5 mcg inhalation aerosol (Symbicort, generic [including Breyna]) — Cigna

asthma (reliever therapy)

Initial criteria

  • Patient has asthma AND is using budesonide/formoterol (Symbicort, generic [including Breyna]) as a reliever therapy