Ohtuvayre — Medical Mutual

Chronic Obstructive Pulmonary Disease (COPD)

Initial criteria

Patient is age ≥ 18 years; AND
Patient has symptomatic disease demonstrated by Modified Medical Research Council (mMRC) score ≥ 2 OR COPD Assessment Test (CAT) score ≥ 10; AND
Patient has a diagnosis of COPD confirmed with spirometry (FEV1/FVC ratio < 0.7); AND
Individual has moderate to severe airflow obstruction demonstrated by post-bronchodilator FEV1 30-70% predicted normal; AND
Patient has tried and experienced inadequate efficacy OR significant intolerance with a long-acting muscarinic antagonist (LAMA) product; AND
Patient has tried and experienced inadequate efficacy OR significant intolerance with a long-acting beta-agonist (LABA) product; AND
Medication is prescribed by or in conjunction with pulmonary specialist

Patient is age ≥ 18 years; AND
Patient has a diagnosis of COPD confirmed with spirometry (FEV1/FVC ratio < 0.7); AND
Patient has tried and experienced inadequate efficacy OR significant intolerance with a long-acting muscarinic antagonist (LAMA) product; AND
Patient has tried and experienced inadequate efficacy OR significant intolerance with a long-acting beta-agonist (LABA) product; AND
Medication is prescribed by or in conjunction with pulmonary specialist; AND
Patient has had a response to therapy including reduced symptoms, reduced frequency of exacerbations, or reduced severity of exacerbations

6 months initial, 1 year reauth