All *ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

Accolate Tablet 10 MG Oral
Accolate Tablet 10 MG Oral

Zafirlukast

Tier: 3
PA Type: No Prior Authorization
ST: N
Accolate Tablet 10 MG Oral
Accolate Tablet 10 MG Oral

Zafirlukast

Tier: 3
PA Type: No Prior Authorization
ST: N
Accolate Tablet 20 MG Oral
Accolate Tablet 20 MG Oral

Zafirlukast

Tier: 3
PA Type: No Prior Authorization
ST: N
Accolate Tablet 20 MG Oral
Accolate Tablet 20 MG Oral

Zafirlukast

Tier: 3
PA Type: No Prior Authorization
ST: N
Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/DOSE Inhalation
Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/DOSE Inhalation

Fluticasone-Salmeterol

Tier: 1
PA Type: No Prior Authorization
ST: N
Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/DOSE Inhalation
Advair Diskus Aerosol Powder Breath Activated 100-50 MCG/DOSE Inhalation

Fluticasone-Salmeterol

Tier: 1
PA Type: No Prior Authorization
ST: N
Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/DOSE Inhalation
Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/DOSE Inhalation

Fluticasone-Salmeterol

Tier: 1
PA Type: No Prior Authorization
ST: N
Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/DOSE Inhalation
Advair Diskus Aerosol Powder Breath Activated 250-50 MCG/DOSE Inhalation

Fluticasone-Salmeterol

Tier: 1
PA Type: No Prior Authorization
ST: N
Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/DOSE Inhalation
Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/DOSE Inhalation

Fluticasone-Salmeterol

Tier: 1
PA Type: No Prior Authorization
ST: N
Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/DOSE Inhalation
Advair Diskus Aerosol Powder Breath Activated 500-50 MCG/DOSE Inhalation

Fluticasone-Salmeterol

Tier: 1
PA Type: No Prior Authorization
ST: N
Advair HFA Aerosol 115-21 MCG/ACT Inhalation
Advair HFA Aerosol 115-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N
Advair HFA Aerosol 115-21 MCG/ACT Inhalation
Advair HFA Aerosol 115-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N