Revefenacin (Yupelri™)

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