- Prior Authorization Required
- COPD (oral):
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
- Step Therapy: COPD (oral):
Incruse Ellipta and 1 of [Spiriva Respimat, Spiriva With HandiHaler]
- Quantity Limit: limit maximum 3 ML PER 1 day(s)
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