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    v1.0.28
    OpenPayerPolicy UpdatesPulmonologyCareOregon Trelegy Ellipta Prior Auth Coverage | O…
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    CurrentcareoregonPolicy N/A

    Trelegy Ellipta (fluticasone-umeclidinium-vilanterol) prior authorization

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    Prior authorization requirements for Trelegy Ellipta (fluticasone-umeclidinium-vilanterol) covering approval length and clinical criteria for members requiring this inhaled combination therapy.

    Policy Summary
    Payercareoregon
    PolicyTrelegy Ellipta (fluticasone-umeclidinium-vilanterol) prior authorization
    Policy CodePolicy N/A
    Change TypeNo material changes
    Effective DateJul 1, 2026
    Next Review DateN/A
    Key ActionSubmit prior authorization with medical records documenting persistent symptoms or exacerbations while on a listed combination inhaler; approvals issued for lifetime through 12/31/2039.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    lifetimeapproval length
    1diagnosis groups
    7/1/2026effective date

    Coverage Criteria for Trelegy Ellipta

    Initial Authorization Criteria

    Covered when ALL of the following are met

    Diagnosis: Member has a diagnosis of asthma OR chronic obstructive pulmonary disease (COPD)
    Documentation: Submission of medical records (e.g., chart notes) confirming persistent symptoms or exacerbations while on a listed combination inhaler

    Examples: for asthma — LABA/ICS (Advair, Symbicort, AirDuo); for COPD — LABA/LAMA (Anoro Ellipta, Stiolto Respimat).

    Trelegy Ellipta prior authorization requires documentation that the member has persistent symptoms or exacerbations despite treatment with an appropriate dual-combination inhaler. Specifically, submit medical records (for example, chart notes) demonstrating ongoing disease activity while on a listed combination inhaler. For asthma, the required prior inhaler class is LABA/ICS (examples cited: Advair, Symbicort, AirDuo). For COPD, the required prior inhaler class is LABA/LAMA (examples cited: Anoro Ellipta, Stiolto Respimat).

    Prior authorization is required for Trelegy Ellipta. Approvals are issued for a lifetime period with an expiration date of 12/31/2039. Include the clinical documentation described above to support the request; lack of these records may result in denial.

    Policy Summary
    Payercareoregon
    PolicyTrelegy Ellipta (fluticasone-umeclidinium-vilanterol) prior authorization
    Policy CodePolicy N/A
    Change TypeNo material changes
    Effective DateJul 1, 2026
    Next Review DateN/A
    Key ActionSubmit prior authorization with medical records documenting persistent symptoms or exacerbations while on a listed combination inhaler; approvals issued for lifetime through 12/31/2039.
    SourceLink
    On This Page
    Coverage Criteria for Trelegy ElliptaProvider Requirements and Authorization DetailsKey DefinitionsBackground

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Provider Requirements and Authorization Details

    Prior Authorization

    Prior authorization required; approval length

    Prior authorization is required for Trelegy Ellipta. Approvals are issued for the lifetime period ending 12/31/2039.

    Step Therapy

    Step therapy: trial of specified combination inhaler required

    Member must have persistent symptoms or exacerbations while receiving a specified dual-combination inhaler before Trelegy Ellipta will be approved.

    • For asthma: persistent symptoms/exacerbations while on a LABA/ICS (examples listed: Advair, Symbicort, AirDuo).
    • For COPD: persistent symptoms/exacerbations while on a LABA/LAMA (examples listed: Anoro Ellipta, Stiolto Respimat).
    Documentation Required

    Required clinical records (chart notes)

    Submit medical records (for example, chart notes) documenting persistent symptoms or exacerbations while the member was treated with an alternative listed combination inhaler.

    • Documentation must confirm symptoms or exacerbations on a LABA/ICS for asthma or a LABA/LAMA for COPD (examples above).
    Denial Risk

    Missing documentation may trigger denial

    If medical records confirming persistent symptoms or exacerbations while on the specified prior combination inhaler are not submitted, the request may be denied.

    Key Definitions

    LABA/ICS — definition and examples
    DefinitionLong-acting beta agonist combined with an inhaled corticosteroid.
    Common examplesAdvair (fluticasone/salmeterol), Symbicort (budesonide/formoterol), AirDuo (generic and brand albuterol/For ICS+LABA combination noted in policy).
    Clinical contextRequired as a prior therapy for asthma patients who continue to have persistent symptoms or exacerbations before Trelegy Ellipta is authorized.
    Documentation requiredSubmission of medical records (e.g., chart notes) confirming persistent symptoms or exacerbations while on a LABA/ICS is required for authorization.
    LABA/LAMA — definition and examples
    DefinitionLong-acting beta agonist combined with a long-acting muscarinic antagonist.
    Common examplesAnoro Ellipta (umeclidinium/vilanterol), Stiolto Respimat (tiotropium/olodaterol).
    Clinical contextRequired as a prior therapy for COPD patients who continue to have persistent symptoms or exacerbations before Trelegy Ellipta is authorized.
    Documentation requiredSubmission of medical records (e.g., chart notes) confirming persistent symptoms or exacerbations while on a LABA/LAMA is required for authorization.

    Background

    Trelegy Ellipta is a triple‑combination inhaler containing an inhaled corticosteroid (ICS), a long‑acting muscarinic antagonist (LAMA), and a long‑acting beta agonist (LABA). It is intended for patients with asthma or chronic obstructive pulmonary disease (COPD) who continue to have symptoms or exacerbate despite appropriate dual‑combination therapy. Authorization is contingent on documented failure or persistent disease activity while on recommended LABA/ICS (for asthma) or LABA/LAMA (for COPD) combinations.