Yupelri (revefenacin inhalation solution) — United Healthcare
moderate to severe chronic obstructive pulmonary disease (COPD)
Preferred products
- Spiriva Handihaler (tiotropium)
- Spiriva Respimat (tiotropium)
Initial criteria
- Diagnosis of moderate to severe chronic obstructive pulmonary disease (COPD)
- AND one of the following:
- History of failure, contraindication or intolerance to Spiriva Handihaler or Respimat (tiotropium)
- OR patient is unable to use a metered-dose, dry powder or slow mist inhaler (e.g., Spiriva Respimat) due to one of the following:
- Cognitive or physical impairment limiting coordination of handheld devices (e.g., cognitive decline, arthritis in the hands) (Document impairment)
- Patient is unable to generate adequate inspiratory force (e.g., peak inspiratory flow rate (PIFR) resistance is <60 L/min)
Reauthorization criteria
- Documentation of positive clinical response to therapy
Approval duration
12 months