All *ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

Albuterol Sulfate ER Tablet Extended Release 12 Hour 4 MG Oral
Albuterol Sulfate ER Tablet Extended Release 12 Hour 4 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate ER Tablet Extended Release 12 Hour 8 MG Oral
Albuterol Sulfate ER Tablet Extended Release 12 Hour 8 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate ER Tablet Extended Release 12 Hour 8 MG Oral
Albuterol Sulfate ER Tablet Extended Release 12 Hour 8 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation
Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation
Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation

Tier: 1
PA Type: No Prior Authorization
ST: N
Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation
Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation

Tier: 1
PA Type: No Prior Authorization
ST: N