Sutter Health Plus
Daliresp (roflumilast)
Drugs for the Lungs : Drugs for Asthma/COPD
  • Prior Authorization: PA Applies
  • Prior Authorization: Diabetic Medical Supplies:
    Documented Diagnosis: Yes
    Duration: 1 plan year
    Reauthorization Required: Yes

  • Quantity Limit: limit maximum 200 EA PER 30 day(s)
  • Prior Authorization: Glaucoma:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)