Albuterol tablets — United Healthcare
obstructive airway disease (e.g., asthma)
Preferred products
- albuterol HFA (generic ProAir HFA, generic Proventil HFA, generic Ventolin HFA)
Initial criteria
- Diagnosis of obstructive airway disease (e.g., asthma)
- Patient’s obstructive airway disease is being managed with BOTH of the following: 1) ONE of the following controller medications: a) an inhaled corticosteroid (e.g., Arnuity Ellipta, QVAR RediHaler) OR b) an inhaled corticosteroid/long-acting beta-agonist [e.g., fluticasone/salmeterol (generic Advair Diskus), Advair HFA, Breo Ellipta, Symbicort] OR c) Spiriva HandiHaler/Respimat OR d) a long-acting muscarinic antagonist/long-acting beta-agonist (e.g., Anoro Ellipta, Bevespi Aerosphere); AND 2) History of failure, contraindication, or intolerance to an inhaled short-acting beta-agonist [e.g., albuterol HFA (generic ProAir HFA, generic Proventil HFA, generic Ventolin HFA)]
- Prescriber attests that the benefits outweigh the risk
Reauthorization criteria
- Documentation of positive clinical response to therapy
Approval duration
12 months