- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Prior Authorization: COPD (oral):
Duration: 12 Month(s)
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
COPD associated with chronic bronchitis: Yes
History of COPD exacerbation: Yes
Documented Diagnosis: Yes
- COPD (oral):
Duration: 12 Month(s)
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
COPD associated with chronic bronchitis: Yes
History of COPD exacerbation: Yes
Documented Diagnosis: Yes
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