Beta-Agonists, Inhaled Long Acting
PDL Reference Documents
Newsletters
- August 2023 - 2023 Global Initiative for Chronic Obstructive Lung Disease Report: Focus on Revised Recommendations for Inhaler Products
- May 2017 - Updates in the Management of Chronic Obstructive Pulmonary Disease
- June 2013 - Updates and Future Perspectives in the Management of Stable Chronic Obstructive Pulmonary Disease
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 |
|---|---|---|---|---|---|
| salmeterol xinafoate | SEREVENT DISKUS | BLST W/DEV | Y | ||
| arformoterol tartrate | BROVANA | VIAL-NEB | N | PA Document | |
| arformoterol tartrate | ARFORMOTEROL TARTRATE | VIAL-NEB | N | PA Document | |
| formoterol fumarate | FORMOTEROL FUMARATE | VIAL-NEB | N | PA Document | |
| formoterol fumarate | PERFOROMIST | VIAL-NEB | N | PA Document | |
| olodaterol HCl | STRIVERDI RESPIMAT | MIST INHAL | N | PA Document | Jan 29, 2015 |