Limited Coverage Drugs - Glycopyrronium
Generic Name |
glycopyrronium |
---|---|
Strength |
50 µg / capsule for inhalation |
Form |
inhaler |
Special Authority Criteria |
Approval Period |
---|---|
Diagnosis of COPD where spirometry measures are:
OR
Notes:
|
Indefinite |
Practitioner Exemptions
-
Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
- Respirology.
Special Notes
-
The dose of glycopyrronium should not exceed 50 mcg per day.
- In remote areas, where spirometry access is limited, spirometry measurements are to be provided within 6 months.