Limited Coverage Drugs - Indacaterol Maleate

Generic Name

indacaterol maleate
Strength 75 mcg
Form micronized powder for inhalation

Special Authority Criteria

Approval Period

Diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

AND

Inadequate response to optimal short acting beta agonist therapy

AND

Dosage does not exceed 75 mcg per day.

Indefinite

Practitioner Exemptions

  • Respirologists are not required to submit a Special Authority Request form for coverage.

Special Notes

  • None

Special Authority Request Form(s)