YUPELRI (revefenacin)
SELF ADMINISTRATION - NEBULIZED INHALATION
Indications for Prior Authorization:
- Indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD)
Patients must meet the following criteria for the indication(s) above:
- Diagnosis of COPD, AND
- Patient is at least 18 years of age or older, AND
- Patient has a documented need for nebulized LAMA therapy (e.g. impaired dexterity, altered cognition, or chronic muscle weakness).
Dosing:
- One 175 mcg vial (3 mL) administered once daily by nebulizer using a mouthpiece
Approval:
- 1 year
Last review date: December 4, 2019