Standard Health Pals Formulary
Fluticasone 500 mcg / Salmeterol 50 mcg Metered Dose Inhalation Powder (Generic for Advair and Wixela)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Advair and Wixela