*ANTIASTHMATIC AND BRONCHODILATOR AGENTS* – Exemplar Health Benefits Administrator

Accolate Tablet 10 MG Oral

Zafirlukast

Tier: 3

PA Type: No Prior Authorization

ST: N

Accolate Tablet 10 MG Oral

Zafirlukast

Tier: 3

PA Type: No Prior Authorization

ST: N

Accolate Tablet 20 MG Oral

Zafirlukast

Tier: 3

PA Type: No Prior Authorization

ST: N

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

Fluticasone-Salmeterol

Tier: 1

PA Type: No Prior Authorization

ST: N

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

Fluticasone-Salmeterol

Tier: 1

PA Type: No Prior Authorization

ST: N

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

Fluticasone-Salmeterol

Tier: 1

PA Type: No Prior Authorization

ST: N

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

Fluticasone-Salmeterol

Tier: 2

PA Type: No Prior Authorization

ST: N

Advair HFA Aerosol 115-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2

PA Type: No Prior Authorization

ST: N