Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
salmeterol OR salmeterol in combination with fluticasone

Criteria Approval Period
1. Diagnosis of asthma
PLUS
inadequate response on optimal dose of inhaled corticosteroid.

OR

2. Diagnosis of COPD
PLUS
inadequate response on optimal short acting beta agonist therapy.

 Indefinite

Practitioner Exemptions

  • Respirologists
  • Allergists

Special Notes

  • None

Online Forms (PDF)
Click on the link to complete a special authority request form.