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    v1.0.30
    OpenPayerPolicy UpdatesPharmacy & Specialty DrugsOklahoma Health Care Brovana Coverage | OpenPayer
    Ask Trek AI about this page
    CurrentOklahoma Health Care AuthorityPolicy N/A

    Brovana (arformoterol tartrate) Coverage Criteria

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    This Oklahoma Health Care Authority annual review governs coverage and prior authorization for Brovana (arformoterol tartrate) for adult members with COPD, chronic bronchitis, or emphysema. It maintains the existing approval criteria and quantity limit, with no changes recommended.

    Policy Summary
    PayerOklahoma Health Care Authority
    PolicyBrovana (arformoterol tartrate) Coverage Criteria
    Policy CodePolicy N/A
    Change TypeNo material changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionDocument the member's age, qualifying diagnosis, prior trial with Advair, Serevent, or Foradil within the past 45 days, or the applicable clinical exception.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    412011 Brovana claims
    $15,416.772011 Brovana cost
    120 mLQuantity limit per 30-day supply
    14 approvedPrior authorization outcomes
    3 deniedPrior authorization outcomes
    Policy Summary
    PayerOklahoma Health Care Authority
    PolicyBrovana (arformoterol tartrate) Coverage Criteria
    Policy CodePolicy N/A
    Change TypeNo material changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionDocument the member's age, qualifying diagnosis, prior trial with Advair, Serevent, or Foradil within the past 45 days, or the applicable clinical exception.
    SourceLink
    On This Page
    Brovana Coverage CriteriaPrior Authorization RequirementsPolicy BackgroundInitial AuthorizationRequired Prior TherapyBrovana Quantity Limit

    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.

    11 incompletePrior authorization outcomes

    Brovana Coverage Criteria

    Initial Brovana Therapy

    Covered when ALL of the following criteria are met:

    ALL of the following

    • Member is age 18 or older.
    • Member has a diagnosis of COPD, chronic bronchitis, or emphysema.

    • ONE of the following

      • Member has had a prior trial with Advair®, Serevent®, or Foradil® within the past 45 days.
      • Member is unable to effectively use hand-actuated devices or is stable on nebulized therapy; a clinical exception applies.
    • Quantity is limited to 120 mL for a 30-day supply.

    Prior Authorization Requirements

    Prior Authorization

    Brovana Approval Criteria

    Submit prior authorization for Brovana™ (arformoterol tartrate) only when the member is age 18 or older and has COPD, chronic bronchitis, or emphysema. Approval also requires the applicable prior inhaled therapy trial or clinical exception and adherence to the quantity limit.

    • Member must be age 18 or older.
    • Qualifying diagnosis: COPD, chronic bronchitis, or emphysema.
    Step Therapy

    Prior Inhaled Therapy Trial

    Document a prior trial with Advair®, Serevent®, or Foradil® within the past 45 days before requesting Brovana approval.

    • Required prior therapies: Advair®, Serevent®, or Foradil®.
    • Trial must have occurred within the past 45 days.

    Policy Background

    Brovana (arformoterol tartrate) is reviewed for adult members with COPD, chronic bronchitis, or emphysema. Prior authorization review considers the member’s prior inhaled therapy experience and whether a clinical exception applies because the member cannot effectively use hand-actuated devices or is stable on nebulized therapy.

    Initial Authorization

    Initial Authorization

    Brovana is authorized when the member meets the age and diagnosis requirements and satisfies the prior-therapy or clinical-exception requirement.

    Initial authorization eligibility

    • Age and qualifying diagnosis: Member is age 18 or older and has a diagnosis of COPD, chronic bronchitis, or emphysema.age >= 18

    • Prior therapy or clinical exception

      • Prior therapy trial: Prior trial with Advair, Serevent, or Foradil within the past 45 days.within the past 45 days

    Required Prior Therapy

    StepRequirementTimeframe
    1Prior trial with Advair, Serevent, or ForadilWithin the past 45 days

    Brovana Quantity Limit

    Quantity Limits
    MedicationBrovana (arformoterol tartrate)
    Quantity limit120 mL
    Supply period30-day supply
    Documentation Required

    Clinical Eligibility Documentation

    Include clinical documentation supporting the member’s age, qualifying diagnosis, and prior inhaled therapy trial. If the trial requirement is not met, document the applicable clinical exception: inability to effectively use hand-actuated devices or stability on nebulized therapy.

    • Document inability to effectively use hand-actuated devices, when applicable.
    • Document that the member is stable on nebulized therapy, when applicable.
    Denial Risk

    Denial and Quantity-Limit Conditions

    Requests that do not meet the approval criteria may be denied. The quantity limit is 120 mL for a 30-day supply; quantities exceeding this limit are subject to denial unless otherwise approved under applicable policy requirements.

    • Quantity limit: 120 mL per 30-day supply.
    • Failure to meet age, diagnosis, prior-therapy, or clinical-exception requirements may result in denial.
    Clinical exception: Member is unable to effectively use hand-actuated devices or is stable on nebulized therapy.