| Anthem Blue Cross (HMO, PPO, EPO) |
| Breztri Aerosphere (budesonide-glycopyr-formoterol) |
| Drugs for the Lungs : Drugs for Cystic Fibrosis |
- Step Therapy Applies
- Quantity Limit: 1 inhaler per 30 day(s).
- COPD (oral):
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
COPD associated with chronic bronchitis: No
History of COPD exacerbation: No
Documented Diagnosis: Yes
- Prior Authorization: COPD (oral):
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
COPD associated with chronic bronchitis: No
History of COPD exacerbation: No
Documented Diagnosis: Yes
|