LONHALA MAGNAIR (glycopyrrolate)
SELF ADMINISTRATION
Indications for Prior Authorization:
- Long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema
Patients must meet the following criteria for the indication(s) above:
- Diagnosis of COPD, AND
- Member is at least 18 years or older, AND
- Member has a documented need for nebulized LAMA therapy (e.g. impaired dexterity, altered cognition, or chronic muscle weakness), AND
- Member has tried and failed preferred Yupelri
Dosing:
- 1 vial in the morning and 1 vial in the evening every day
- Store vials in the foil pouch and only remove immediately before use with Magnair
Approval:
- 1 year
Last review date: April 23, 2019