Health Net
Perforomist (formoterol fumarate)
Drugs for the Lungs : Drugs for Asthma/COPD
  • Prior Authorization Required
  • Step Therapy: COPD (oral):
    Serevent Diskus and Striverdi Respimat
  • COPD (oral):
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    COPD associated with chronic bronchitis: No
    History of COPD exacerbation: No
    Documented Diagnosis: Yes

  • Quantity Limit: limit maximum 4 ML PER 1 day(s)