Limited Coverage Drugs – salmeterol

Generic Name

salmeterol

Strength

50 mcg

Form

dry powder for oral inhalation

Special Authority Criteria

Approval Period

  1. Diagnosis of asthma

AND

inadequate response on optimal dose of inhaled corticosteroid.

Indefinite

  1. Diagnosis of chronic obstructive pulmonary disease (COPD) defined where a spirometry measure is:
  • A post-bronchodilator fixed ratio of forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 0.70

AND

Contraindication or intolerance to a long-acting muscarinic receptor antagonist (LAMA)

Indefinite

Practitioner Exemptions

The following practitioners are not required to submit a Special Authority request form for coverage:

  • Respirologists for asthma and COPD
  • Allergists for asthma

Special Notes

  • In remote areas, where spirometry access is limited, spirometry measurements are to be provided within 6 months.

Special Authority Request Form(s)