Respiratory Agents
Cough and Cold Preparations
Brand/Generic Name
Dosage/Strength
Status
Restrictions
Notes
Relative Cost
Promethazine-DM
Promethazine-DM
$
Key for Product(s) Listed Above
Formulary
Prior Authorization (PA may not be required for some benefit plans)
Non-Formulary
(Third tier coverage applies for selected plans)
Not Reimbursed
Quantity Limit
Not available through mail order as 90-day supply*
Step Therapy
Generic Available
Notes
$
Relative cost compared to others in category
Specialty distribution for selected plans
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Respiratory Agents
