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Beta-Agonists Long Acting

DrugsLong Acting Inhaled Beta-Agonists

January 2018

Therapeutic area - Respiratory/COPD

Preferred and nonpreferred drugs

Preferred Nonpreferred
Serevent inhaler (salmoterol) Arcapta Neohaler (indacaterol inhalation powder)
Foradil Inhaler (formoterol) Brovana nebulization (arformoterol for nebulization)
Perforomist nebulization (formoterol for nebulization)
Striverdi Respimat (olodaterol inhalaton spray)

Approval criteria

  • Patient has a diagnosis of COPD AND one of the following:
  • Patient has tried and failed Serevent or Foradil OR
  • Patient has manual dexterity issues that would prevent use of Serevent or Foradil. Dexterity issues must be supported in clinical notes and supplied at time of request OR
  • Patient has a documented contraindication to Serevent and Foradil
  • Patient must not have any LAMA/LABA inhalers

Quantity limits

  • One inhaler per month


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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