Inhaled Anticholinergics (Revised)

By April 15, 2024: Billing team must update clinical decision support and prior authorization protocols in billing software to enforce step-therapy requirements for Atrovent HFA aerosol inhaler and Combivent Respimat solution. Pharmacy/clinical staff must verify that members have documentation of prior treatment with either Ventolin HFA or ipratropium bromide inhalation solution before approving claims for these medications. Update pharmacy benefit management (PBM) system rules to require step-therapy verification. Billing team should audit recent claims (past 30 days) to identify any denials or rejections due to failure to meet step-therapy criteria. Providers should be notified of this requirement to ensure prior authorization requests include documentation of prerequisite therapy. Failure to enforce step-therapy will result in claim denials and member out-of-pocket costs.