Which Inhalers does CareOregon Medicaid Cover?

Posted on Nov 19, 2018 @ 2:35 PM
Which Inhalers does CareOregon Cover?
Weight :
Flovent Inhaler

By Marine Schmitt, PharmD

CareOregon has created treatment pathways for chronic obstructive pulmonary disease (COPD; figure 1) and asthma (figure 2) to align treatment guidelines, and our preferred inhalers, in a manner that is more user friendly. Please note, these pathways reflect CareOregon’s Medicaid (OHP) line-of-business. 

COPD

The treatment pathway follows the GOLD guidelines for COPD. The preferred short-acting beta agonist (SABA) is Ventolin. As symptoms increase, a long-acting muscarinic antagonist (LAMA) or long-acting beta agonist (LABA) should be added. As of October 1st, CareOregon will no longer prefer Spiriva as the LAMA of choice. Instead, Incruse Ellipta will be the preferred LAMA for COPD patients. The next step in the pathway is to use a combination LAMA/LABA agent. CareOregon covers both Stiolto Respimat (tiotropium/olodaterol) and Anoro Ellipta (umeclidinium/vilanterol) as options in this class. If there are continued exacerbations on the LAMA/LABA agent, an inhaled corticosteroid (ICS) should be added to the regimen. CareOregon covers the triple ingredient inhaler, Trelegy, which contains a LAMA (umeclidium), LABA (vilanterol), and ICS (fluticasone). Advair and Symbicort are no longer preferred therapies for COPD management. GOLD Guidelines recommend ICS/LABA only in unique populations. Their use requires Prior Authorization.
incruse ellipta inhaler
Incruse Ellipta

Asthma

The asthma treatment pathway is based on the Expert Panel Report 3 Asthma guidelines. The preferred formulary inhaler for a SABA is still Ventolin. The preferred formulary ICS’s for asthma include Qvar RediHaler and Flovent. CareOregon recommends using one puff BID regimens and increasing the potency as more ICS is required rather than using two puffs twice daily. If therapy needs to be escalated further, the next step is to switch to a combination LABA/ICS inhaler. CareOregon’s preferred LABA/ICS is now generic AirDuo (salmeterol/fluticasone). Advair and Symbicort are no longer preferred agents for asthma on the CareOregon formulary.

Ventolin inhaler
Ventolin

Qvar Inhaler
Qvar RediHaler
Flovent Inhaler
Flovent


All agents listed do not require Prior Authorization with the exception of those in severe COPD (Advair, Symbicort and Trelegy).



Figure 1: CareOregon’s COPD treatment pathway

CareOregon COPD Treatment Pathway

Abbreviations: COPD = chronic obstructive pulmonary disorder; ICS = inhaled corticosteroid; LABA = long acting beta-agonist; LAMA = long acting muscarinic agonist

 

Figure 2: CareOregon’s Asthma treatment pathway
CareOregon Athsma Treatment Pathway


Review of CareOregon’s Inhaler Quantity Limits
–Marine Schmitt, PharmD

Formulary Product

Quantity limits

Notes

Flovent Diskus

1 inhaler per 2 months

CareOregon limits Qvar 40 mcg to two puffs twice daily to encourage use of Qvar 80 mcg, if higher dose is needed.

 

For Trelegy to adjudicate at the pharmacy, member needs the presence of a claim for Breo Ellipta, Advair, Symbicort or Stiolto in the last 180 days. If the member has Medicaid and has been taking LAMA/LABA or LABA/ICS combination through two single agent inhalers, a prior authorization is needed for approval.

Flovent HFA

1 inhaler per 2 months

Generic AirDuo

2 inhalers per month

Qvar Redihaler

1 inhaler per 2 months

Ventolin/Proair

None

Serevent

None

Stiolto Respimat

1 inhaler per month

Anoro Ellipta

1 inhaler per month

Incruse Ellipta

1 inhaler per month

Trelegy

1 inhaler per month


Categories :
  • Provider
Tags :