LAMA/LABA Combination

Drug - Inhaled LAMA/LABA Combination (Long-Acting Antimuscarinic Antagonist/Long-Acting Beta2 Agonist)

October 2017

Therapeutic area - COPD

Preferred

• Stiolto Respimat (tiotropium/olodaterol) [Boehringer Ingelheim]

Nonpreferred

• Anoro Ellipta (umeclidinium/vilanterol) [GSK]
• Bevespi Aerosphere (glycopyrrolate/formoterol) [AstraZeneca]
• Utibron Neohaler (glycopyrrolate/indacaterol) [Sunovion]

Approval criteria for nonpreferred products

• Patient must be 18 years of age or older AND
• Patient has a diagnosis of COPD AND
• Patient has tried and failed the preferred product

Quantity limits

1 inhaler per 30-day supply

Questions?

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