All *ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

Advair HFA Aerosol 230-21 MCG/ACT Inhalation
Advair HFA Aerosol 230-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N
Advair HFA Aerosol 230-21 MCG/ACT Inhalation
Advair HFA Aerosol 230-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N
Advair HFA Aerosol 230-21 MCG/ACT Inhalation
Advair HFA Aerosol 230-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N
Advair HFA Aerosol 45-21 MCG/ACT Inhalation
Advair HFA Aerosol 45-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N
Advair HFA Aerosol 45-21 MCG/ACT Inhalation
Advair HFA Aerosol 45-21 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: 2
PA Type: No Prior Authorization
ST: N
AirDuo Digihaler Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation
AirDuo Digihaler Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation

Fluticasone-Salmeterol(sensor)

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AirDuo Digihaler Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation
AirDuo Digihaler Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation

Fluticasone-Salmeterol(sensor)

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AirDuo Digihaler Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation
AirDuo Digihaler Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation

Fluticasone-Salmeterol(sensor)

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AirDuo RespiClick 113/14 Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation
AirDuo RespiClick 113/14 Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AirDuo RespiClick 232/14 Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation
AirDuo RespiClick 232/14 Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
AirDuo RespiClick 55/14 Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation
AirDuo RespiClick 55/14 Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation

Fluticasone-Salmeterol

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate ER Tablet Extended Release 12 Hour 4 MG Oral
Albuterol Sulfate ER Tablet Extended Release 12 Hour 4 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N