Miscellaneous Pulmonary Agents
PDL Reference Documents
- COPD Class Update - Dec 05, 2024
- Asthma and COPD maintenance medications - Oct 01, 2020
- Asthma Biologics - Jul 26, 2018
- Monoclonal Antibodies for Asthma - Jul 28, 2016
- Asthma and COPD - Sep 24, 2015
- COPD/Asthma Class Update - Jul 31, 2014
- COPD Class Update and Breo Ellipta New Drug Evaluation - Nov 21, 2013
- Class Scan: COPD Medications - Sep 26, 2013
- Drug Class Review: Controller Medications for Asthma - Jul 25, 2013
- Class Update: Asthma Controllers - May 31, 2012
- Abbreviated Class Review: COPD - Feb 23, 2012
Newsletters
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
---|---|---|---|---|---|
montelukast sodium | MONTELUKAST SODIUM | TAB CHEW | Y | ||
montelukast sodium | SINGULAIR | TAB CHEW | Y | ||
montelukast sodium | MONTELUKAST SODIUM | TABLET | Y | ||
montelukast sodium | SINGULAIR | TABLET | Y | ||
ensifentrine | OHTUVAYRE | AMPUL-NEB | N | PA Document | |
montelukast sodium | SINGULAIR | GRAN PACK | N | ||
montelukast sodium | MONTELUKAST SODIUM | GRAN PACK | N | ||
roflumilast | DALIRESP | TABLET | N | PA Document | Feb 23, 2012 |
roflumilast | ROFLUMILAST | TABLET | N | PA Document | |
zafirlukast | ZAFIRLUKAST | TABLET | N | ||
zafirlukast | ACCOLATE | TABLET | N | ||
zileuton | ZYFLO | TABLET | N | ||
zileuton | ZILEUTON ER | TBMP 12HR | N |