Limited coverage drugs – tiotropium
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|
Generic name |
tiotropium (Handihaler® ONLY) |
|---|---|
|
Strength |
18 mcg |
|
Form |
dry powder for oral inhalation |
|
Special Authority criteria |
Approval period |
|---|---|
|
Diagnosis of chronic obstructive pulmonary disease (COPD) AND Failure after a minimum one-month trial of EACH of the regular benefit long-acting muscarinic receptor antagonist (LAMA) products (see notes) |
Indefinite |
Practitioner exemptions
- None
Special notes
The Regular Benefit LAMA products are the following:
- tiotropium (Spiriva® Respimat®)
- umeclidinium (Incruse® Ellipta®)
Special Authority requests
- Log in to eForms
- HLTH 5362 - COPD form (PDF, 100KB)
