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    • Trek Health
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    v1.0.30
    OpenPayerPolicy UpdatesPulmonologyOK Health Care Authority Brovana Coverage | OpenPa…
    Ask Trek AI about this page
    CurrentOklahoma Health Care AuthorityPolicy N/A

    Brovana (arformoterol tartrate) Coverage Criteria

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    This annual review governs prior authorization and quantity limits for Brovana nebulized therapy for Oklahoma Health Care Authority members. It applies to adults with COPD, chronic bronchitis, or emphysema who meet the stated prior-treatment or clinical-exception criteria.

    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 ActionSubmit prior authorization for members age 18 or older with a qualifying diagnosis, required prior therapy or clinical exception, and requested quantity within 120 mL per 30 days.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    18+Minimum member age
    120 mLQuantity limit
    6Members in FY2010
    14Claims in FY2010
    $4,864.39FY2010 cost
    No changesReview recommendation

    Initial Brovana Approval

    Initial Brovana approval

    Brovana is approved when all required criteria are met.

    Required approval criteria

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

    • Prior therapy or clinical exception

      • Prior alternative therapy: Prior trial with Advair, Serevent, or Foradil within the past 45 days.Within 45 days
    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 ActionSubmit prior authorization for members age 18 or older with a qualifying diagnosis, required prior therapy or clinical exception, and requested quantity within 120 mL per 30 days.
    SourceLink
    On This Page
    Initial Brovana ApprovalQuantity and Eligibility ParametersPrior Authorization RequirementsBrovana Therapy Overview

    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.

    Clinical exception:
    Member is unable to effectively use hand-actuated devices or is stable on nebulized therapy.
  1. Quantity limit: Requested quantity is within the applicable limit.120 mL per 30-day supply

    2. Quantity and Eligibility Parameters

    Brovana Quantity Limit
    Quantity limit120 mL
    Supply period30-day supply
    Applies toBrovana therapy
    Prior Alternative-Therapy Trial
    Required trial windowWithin the past 45 days
    Alternative therapiesAdvair, Serevent, or Foradil
    Clinical exceptionApplies when the member cannot effectively use hand-actuated devices or is stable on nebulized therapy
    Minimum Member Age
    Minimum member age18 years or older
    Eligible populationAdult members
    Approval requirementMember must meet the minimum age criterion

    Prior Authorization Requirements

    Prior Authorization

    Brovana Approval Criteria

    Brovana (arformoterol tartrate) requires prior authorization. Approval requires the member to be age 18 or older, have a qualifying respiratory diagnosis, and meet the prior-treatment or clinical-exception requirements below. A quantity limit of 120 mL per 30-day supply also applies.

    • Member must be age 18 or older.
    • Qualifying diagnosis must be COPD, chronic bronchitis, or emphysema.
    • Quantity is limited to 120 mL for a 30-day supply.
    Step Therapy

    Prior Trial of Alternative Inhaled Therapy

    Document a prior trial of an alternative inhaled therapy within the preceding 45 days, unless the member qualifies for a clinical exception.

    • Prior trial must include Advair, Serevent, or Foradil within the past 45 days.
    • A clinical exception may apply when the member is unable to effectively use hand-actuated devices or is stable on nebulized therapy.
    Denial Risk

    Failure to Meet Approval Criteria

    The request is subject to denial when required eligibility, diagnosis, prior-treatment, or clinical-exception criteria are not met. Requests that do not satisfy the approval requirements should not be approved.

    • Member is younger than 18.
    • No qualifying diagnosis of COPD, chronic bronchitis, or emphysema is documented.
    • Required prior trial is absent and no qualifying clinical exception is documented.
    Documentation Required

    Incomplete Authorization Request

    Incomplete prior authorization submissions are associated with denial. Submit all information needed to establish eligibility, diagnosis, prior therapy, and any applicable clinical exception.

    • Include documentation of the member's age and qualifying diagnosis.
    • Include the prior Advair, Serevent, or Foradil trial, or documentation supporting a clinical exception.

    Brovana Therapy Overview

    Brovana (arformoterol tartrate) is reviewed for adult members with COPD, chronic bronchitis, or emphysema. Coverage requires the member to be 18 years or older and to meet the applicable prior-therapy or clinical-exception requirements.