Limited Coverage Drugs - Umeclidinium in combination with vilanterol
|umeclidinium in combination with vilanterol|
umeclidinium 62.5 mcg /vilanterol 25 mcg
|Form||dry powder for oral inhalation via inhaler|
Diagnosis of Chronic Obstructive Pulmonary Disease (COPD), where spirometry measures are:
- Practitioners in the following specialty are not required to submit a Special Authority request form for coverage: Respirology.
- In remote areas, where spirometry access is limited, spirometry measurements are to be provided within 6 months.
- Patients who meet Special Authority criteria for aclidinium/glycopyrronium/tiotropium will automatically receive coverage of the umeclidinium with vilanterol combination product.
- Patients should be initiated on the umeclidinium with vilanterol combination product only after an inadequate response to monotherapy with either a single-entity long-acting beta agonist (LABA, e.g., formoterol, indacaterol, salmeterol) or a single-entity long-acting muscarinic receptor antagonist (LAMA, e.g., aclidinium, glycopyrronium, tiotropium).
- Daily dose of vilanterol should not exceed 25 mcg; daily dose of umeclidinium should not exceed 62.5 mcg.