AIRSUPRA (albuterol/budesonide)

AIRSUPRA (albuterol/budesonide)

Self-Administration – Inhalation

Diagnosis considered for coverage:

• Asthma: Indicated for the as-needed treatment or prevention of bronchoconstriction and to reduce the risk of exacerbations in patients with asthma 18 years of age and older.

Coverage Criteria:

• Requested drug is being used for a Food and Drug Administration (FDA)-approved indication, AND
• Both of the following:
  • Trial of or intolerance to inhaled corticosteroid (ICS) and albuterol, AND
  • Trial and failure (of a minimum 30-day supply), contraindication, or intolerance to Symbicort (budesonide/formoterol)

Reauthorization Criteria:

• Documentation of a positive clinical response to therapy.

Coverage Duration:

• Initial: 12 months
• Reauthorization: 12 months

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information:

• Airsupra (albuterol/budesonide) inhalation aerosol is a combination of albuterol (a SABA), and budesonide (a corticosteroid), indicated for the as-needed treatment or prevention of bronchoconstriction and to reduce the risk of exacerbations in patients with asthma ≥ 18 years of age.
• Dosing
  • The recommended dosage of Airsupra is albuterol 180 mcg and budesonide 160 mcg (administered as 2 actuations of Airsupra [albuterol/budesonide 90 mcg/80 mcg]) as needed for asthma symptoms by oral inhalation. Do not take more than 6 doses (12 inhalations) in a 24-hour period.

Policy Updates:

• 02/20/2024 – New policy approved by P&T.

References:

1. Airsupra Prescribing Information. AstraZeneca Pharmaceuticals LP. Wilmington, DE. January 2023.