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    Beta-Agonists Long Acting

    Drugs - Long 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

    Questions?

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

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