PROAIR DIGIHALER (albuterol)

PROAIR DIGIHALER (albuterol)

Self-Administration – inhalation

Diagnosis considered for coverage:

• Indicated for the treatment or prevention of bronchospasm in patients 4 years of age and older with reversible obstructive airway disease
• Indicated for the prevention of exercise-induced bronchospasm in patients 4 years of age and older

Coverage Criteria:

For diagnosis of bronchospasm or exercise-induced bronchospasm:

• Quantity requested does not exceed 2 inhalers per 30 day supply; AND
• Patient is 4 years of age or older; AND
• Requested drug is being used for a Food and Drug Administration (FDA)-approved indication; AND
• Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure to a minimum 1-day supply, contraindication, or intolerance to 2 of the following:
  • Ventolin
  • Proair Respiclick
  • Generic albuterol inhaler; AND
• Medically appropriate reason supporting the use of the digital component (i.e., rationale why inhaler usage cannot be tracked manually)

Reauthorization Criteria:

For diagnosis of bronchospasm or exercise-induced bronchospasm:

• Quantity requested does not exceed 2 inhalers per 30 day supply; AND
• Patient has experienced a positive clinical response to therapy

Coverage Duration: 

• Initial: 1 year
• Reauthorization: 1 year

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: 

• Recommended dose for bronchospasm: 2 inhalations every 4 to 6 hours by oral inhalation
  • More frequent administration or a larger number of inhalations is not recommended. In some patients, 1 inhalation every 4 hours may be sufficient
• Recommended dose for exercise-induced bronchospasm: 2 inhalations 15 to 30 minutes before exercise by oral inhalation
• Each inhaler is supplied for 200 inhalations

Policy Updates:

• 12/1/2022 – New policy approved by P&T

References:

• ProAir Digihaler Prescribing Information. Teva Respiratory, LLC. Parsippany, NJ. October 2020.