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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
Online Forms (PDF)
Click on the link to complete a special authority request form.
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Last Revised: July 18, 2006
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