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Medications for the Treatment of Chronic Obstructive Pulmonary Disease (COPD)

Coverage of the following medications for the treatment of COPD will be provided to patients who meet established clinical criteria and who are eligible for coverage through the Family Health Benefit, Financial Assistance, Seniors, and Nursing Home Programs. A completed Special Authorization form must be received by the Drug Programs office before coverage will be considered. Patients will be required to pay the normal prescription copays for these programs.

FORMOTEROL

12UG/DOSE POW DER CAPSULE

02230898

FORADIL

NVR

6UG/DOSE POW DER FOR INHALATION (PACKAGE)

02237225

OXEZE TURBUHALER

AZE

12UG/DOSE POW DER FOR INHALATION (PACKAGE)

02237224

OXEZE TURBUHALER

AZE

FORMOTEROL & BUDESONIDE

6UG & 100UG PER DOSE POW DER FOR INHALATION (PACKAGE)

02245385

SYMBICORT TURBUHALER

AZE

6UG & 200UG PER DOSE POW DER FOR INHALATION (PACKAGE)

02245386

SYMBICORT TURBUHALER

AZE

SALMETEROL

50UG/DOSE AEROSOL POW DER DISK (4)

02214261

SEREVENT

GSK

50UG/DOSE POW DER FOR INHALATION (PACKAGE)

02231129

SEREVENT DISKUS

GSK

SALMETEROL & FLUTICASONE

25UG & 125UG PER DOSE INHALER AEROSOL (PACKAGE)

02245126

ADVAIR

GSK

25UG & 250UG PER DOSE INHALER AEROSOL (PACKAGE)

02245127

ADVAIR

GSK

50UG & 100UG POW DER FOR INHALATION (PACKAGE)

02240835

ADVAIR DISKUS

GSK

50UG & 250UG POW DER FOR INHALATION (PACKAGE)

02240836

ADVAIR DISKUS

GSK

50UG & 500UG POW DER FOR INHALATION (PACKAGE)

02240837

ADVAIR DISKUS

GSK

TIOTROPIUM

18UG/DOSE INHALATION POW DER CAPSULE

02246793

SPIRIVA

BOE

PEI Drug Programs Update - Issue 09-01- Page 4

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