Inhaled medications and devices with NLPDP coverage
Posted by dkwinter

See also:

 

Example asthma treatment ladder:

First-line: Salbutamol

 

Second-line: Salbutamol + Fluticasone

 

Third-line: Salbutamol + Fluticasone/Salmeterol (Advair)

  • Advair spec auth req must state
    • compliant with ICS at optimal doses
    • requiring maximal salbutamol
    • require additional control of symptoms due to cough, awakening at night, missing school/work/social activities

 

Fourth-line: Salbutamol + Fluticasone/Salmeterol (Advair) + Montelukast (Singulair)

  • Singulair spec auth req must state
    • despite compliance, not adequately controlled with moderate or high dose ICS and require additional symptom control (e.g. cough, awakening at night, missing work/school, social activities because of asthma symptoms)
    • AND require increasing amounts of SABA indicating poor control

 

 

Example COPD treatment ladder:

First-line: Salbutamol +/- Ipratropium

 

Second-line: Salbutamol +/- Ipratropium + Formoterol (Oxeze)

  • Oxeze spec auth req must state
    • FEV1/FVC<0.7 (at any point in time)
    • 2 or more COPD exac requiring antibiotics and/or oral steroids or 1 COPD exac requiring hospitalization { ..or MRC score >=3   ..or CAT score>=10 and FEV1<80% predicted}

 

Third-line: Salbutamol +/- Ipratropium + Umeclidinium + Vilanterol (Anoro)

  • Anoro spec auth req must state
    • FEV1/FVC<0.7 (at any point in time)
    • Persistent symptoms after >= 1 month of LABA or LAAC and MRC score >=3 or CAT score>=10 

 

Fourth-line: Salbutamol +/- Ipratropium+ Fluticasone/Umeclidinium/Vilanterol (Trelegy)

  • Triple therapy = ICS + LABA + LAAC
    • Considered for COPD if inadequate control with LABA/LAAC for at least 2 months
    • Considered for Asthma/COPD overlap (ACO) if inadequate control (persistent symptoms such as cough, sputum, dyspnea) or experiencing 2 or more COPD exacs in the previous year requiring antibiotics and/or oral steroids or at least 1 COPD exac requiring hospitalization
  •     Trelegy spec auth req must state
    • FEV1/FVC<0.7 (at any point in time)
    • already treated with LABA and LAAC (e.g. Anoro) for at least two months
    • inadequate control
      • 2 or more COPD exac in past year requiring antibiotics and/or oral steroids or 1 COPD exac requiring hospitalization

 

     

Open coverage: Airomir, Ventolin HFA, Bricanyl 

Special auth: nebs, see below:

 

Open coverage: none

Special auth: Foradil, Oxeze, Onbrez, Serevent

 

Open coverage: Atrovent HFA

 

 

Open coverage: none

Special auth: Tudorza genuir, Seebri Breezhaler, Spiriva handihaler & Respimat, Incruse ellipta

 

Open coverage:  Qvar, Pulmicort turbuhaler, Alvesco, Arnuity, Flovent, Asmanex

Special auth: Pulmicort neb

Open coverage: None

Special auth: Symbicort, Breo, Advair, Zenhale

 

Open coverage: None

Special auth: Duaklir genuair, Ultibro Breezhaler, Inspiolto Respimat, Anoro Ellipta

Open coverage: Combivent respimat

 

Special auth: Trelegy