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Long-Acting Muscarinic Antagonists (LAMAs)

DrugLong-Acting Muscarinic Antagonists (LAMAs)

June 2019

Therapeutic area - COPD/Asthma

Preferred

  • Spiriva Handihaler
  • Spiriva Respimat
  • Tudorza Pressair

Nonpreferred

  • Incruse Ellipta
  • Seebri Neohaler
  • Lonhala Magnair

Approval criteria for nonpreferred products

  • Patient must be at least 18 years of age AND
  • Patient has a diagnosis of COPD AND
  • Patient has tried and failed Spiriva Handihaler AND Spiriva Respimat AND Tudorza Pressair OR has a contraindication to Spiriva Handihaler AND Spiriva Respimat AND Tudorza Pressair substantiated by supporting documentation submitted at time of request AND
  • If the request is for Lonhala Magnair, the patient also has tried and failed Seebri Neohaler OR has a contraindication to Seebri Neohaler substantiated by supporting documentation submitted at time of request

Quantity limits

  • Inhaler: 1 inhaler per 30-day supply
  • Lonhala Magnair Starter Kit: 1 starter kit per year
  • Lonhala Magnair Refill Kit: 1 refill kit per 30-day supply

Questions?

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

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