Newfoundland and Labrador Prescription Drug Program
Dear Provider:
Information on the Change in Coverage of Wet Nebulized Medications
A review of the wet nebulized delivery of medications has resulted in a decision to implement a policy change surrounding the coverage status of wet nebulized medications. Effective January 1, 2008, wet nebulized medications are covered only under Special Authorization.
Canadian Asthma Consensus Guidelines (1999), and the Canadian Guidelines for the treatment of COPD, support the use of metered dose inhalers (MDIs) and dry powder inhalers (DPIs) and state that wet nebulization is rarely indicated at any age. MDIs and DPIs offer quick administration, faster reversal of bronchospasm and a more efficient delivery system with as great or greater deposition of medication as compared to wet nebulization. As such, it was decided to change coverage of wet nebulized medications from open benefit status to special authorization. This project was done with the support and participation of respirologists, respiratory therapists and the Lung Association of NL. Both New Brunswick and Nova Scotia have successfully implemented similar program changes in recent years.
Starting in December 2003 NLPDP newsletters have provided updates on the progress of this conversion project including the criteria for coverage, and a continuing education session by Dr. George Fox was held in May 2007 for physicians, pharmacists and nurses to support converting patients from wet nebulized therapy to inhaler therapy. It was encouraged that physicians switch patients to MDIs/DPIs, or send special authorization requests for web nebulized medication coverage, before January 1, 2008.
Special Authorization criteria have been established to accommodate patients for whom a dry delivery method (with or without a spacer device) is inappropriate.
The following outlines the special authorization criteria for coverage of wet nebulized medications:
o Adult patients with a vital capacity of 900 ml or less OR
o Patients with a respiratory rate greater than 25 breaths per minute OR
o Patients who have demonstrated they cannot follow instructions, cannot hold the spacer device or cannot hold the device long enough to actuate it; OR
o Other situations, as deemed appropriate, based on case by case assessment.