Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

salmeterol OR salmeterol in combination with fluticasone

Criteria Approval Period
1. Diagnosis of asthma
PLUS
inadequate response on optimal dose of inhaled corticosteroid.

OR

2. Diagnosis of COPD
PLUS
inadequate response on optimal short acting beta agonist therapy.

Indefinte

Practitioner Exemptions

  • Respirologists
  • Allergists

Special Notes

  • None

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