- 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)
|