The criteria for coverage of all of the new COPD medications are as follows:
For the treatment of mild, moderate, and severe chronic obstructive pulmonary disease (COPD) (i.e. MRC score $
in patients who continue to be symptomatic after a 3 month trial of ipratropium at a dose of 12 puffs/day and appropriate use of short-acting beta2-agonists.
For the treatment of moderate to severe chronic obstructive pulmonary disease (COPD) (i.e. MRC score 3 to 5) without a trial of short-acting agents (e.g. ipratropium and beta2-agonists) where spirometry shows moderate to severe airflow obstruction (i.e. FEV1 < 60% predicted and low FEV1/FVC <0.7). A copy of the spirometry report must accompany the Special Authorization.
The drug programs will not pay for concurrent use of Tiotropium and Ipratropium.
Concurrent use of Tiotropium and Long Acting Beta2-Agonists or Long Acting Beta2-Agonists/Inhaled
Corticosteroids will only be considered in patients where FEV1 < 60% predicted and FEV1/FVC <0.7.
Medical Research Council Dyspnea Scale
Degree of breathlessness related to activities Not troubled by breathlessness except on strenuous exercise Short of breath when hurrying or walking up a slight hill
W alks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
Stops for breath after walking about 100m or after a few minutes on level ground Too breathless to leave the house, or breathless when dressing or undressing
Reference: Fletcher C.M. et al. 1959. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Brit. Med. J. 2:257–66.
Medications for the Treatment of Osteoporosis
The Special Authorization criteria for the coverage of the Etidronate and Calcium Carbonate (Didrocal and generics) have been removed. A Special Authorization is no longer needed for the coverage of these products. Patients will be required to pay the normal prescription copays for these programs.
ETIDRONATE DISODIUM & CALCIUM CARBONATE 400MG & 1250MG TABLET (PACKAGE)
DIDROCAL GEN-ETI-CAL CAREPAC
PGA GPM COB
Coverage of Alendronate, Risedronate, and Calcitonin for the treatment of osteoporosis has been approved for 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.