Breztri prior authorization: What to do if insurance requires it or denies it

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Rebecca Davis

Learn what steps to take if your insurance plan requires prior authorization for Breztri, including how the approval process works and what options may be available if coverage is delayed or denied.

Key takeaways

Breztri’s prior authorization requirements vary by insurance plan, as each health insurance company creates its own coverage criteria and changes its criteria at any time.
Your healthcare provider performs prior authorization forms on your behalf, but you can follow up to make sure it’s been submitted.
Prior authorization can take days to process, but there are ways to get Breztri in the meantime to help avoid COPD or asthma flare-ups.

Breztri Aerosphere (budesonide/glycopyrrolate/formoterol fumarate) is a brand-name inhaler approved by the FDA as a daily maintenance treatment for adults with chronic obstructive pulmonary disease (COPD). It is also approved for daily use in people 12 years and older with asthma.

However, many insurance plans require prior authorization before covering Breztri, which can create delays or barriers to getting the medication. If your request has been denied or you are still waiting for approval, there may be other steps you can take to manage the process and explore available options while you wait for coverage.

What is prior authorization for Breztri?

Prior authorization means your health insurance company requires additional information from your healthcare provider before deciding whether it will cover the cost of Breztri Aerosphere. The medication is not automatically approved until the insurer reviews the request and confirms that coverage requirements are met.

Each insurance company has its own criteria for approving Breztri prior authorization requests. Requirements may vary depending on the plan.

For example, Kaiser Permanente may require that:

The prescription is written by a pulmonologist.
The patient is an adult diagnosed with COPD.
At least one of the following applies:
- The patient has previously tried a combination of inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta agonist (LABA) through separate inhalers for at least 30 days, but the treatment was ineffective, did not provide enough benefit, or caused side effects.
- The patient cannot use other ICS, LAMA, or LABA medications because of possible drug interactions, medical restrictions, or other contraindications.
The healthcare provider can explain why using separate inhalers may not be appropriate or effective for the patient.

Different insurance companies may have different prior authorization requirements for Breztri Aerosphere. For example, some Aetna plans may require the following:

The patient is an adult diagnosed with COPD.
The patient has filled a 30-day prescription for dual therapy, such as:
- Inhaled corticosteroid (ICS) + long-acting beta agonist (LABA), or
- LABA + long-acting muscarinic antagonist (LAMA)
  within the previous 130 days.
At least one of these conditions applies:
- The current dual-therapy medication is not providing adequate symptom control.
- The patient has a blood eosinophil count of at least 300 cells/microliter and has experienced either two or more moderate COPD flare-ups or at least one COPD-related hospitalization within the past year.
Breztri is being prescribed as a maintenance treatment, not as a rescue inhaler.

These examples show that prior authorization requirements can vary significantly between insurance plans. Your healthcare provider may need to schedule an appointment or gather additional medical information to complete the request based on your specific insurance criteria.

Your provider’s office can review the requirements for your health plan and submit the necessary documentation to help support the authorization request.

Why do insurance companies require prior authorization for Breztri?

Health insurance companies often require prior authorization for Breztri Aerosphere because it is a higher-cost medication without a generic version available. Since insurers aim to manage healthcare costs, they may want to confirm whether a lower-cost alternative treatment could be effective before approving coverage.

If you have not tried a Breztri alternative, your insurance plan may require participation in a step-therapy program. Under step therapy, patients may need to try certain medications first, sometimes in a specific order, before the insurance company approves a more expensive option like Breztri.

Your healthcare provider may be able to explain why step therapy is not appropriate for your situation. However, many insurance companies require medical documentation showing that previous treatments were ineffective, caused side effects, or were not suitable before approving Breztri coverage.

How do you get prior authorization for Breztri?

Prior authorization is a process handled primarily between your healthcare provider and your insurance company, with limited involvement required from the patient. The process typically follows these steps:

Step 1: Your healthcare provider submits a PA request

After your healthcare provider sends your Breztri prescription to the pharmacy, they may receive a prior authorization request from your insurance company. The provider will then complete the required forms and submit medical information to support the request.

If additional details are needed, your healthcare provider may schedule an appointment with you to gather the necessary information and ensure the prior authorization paperwork is completed accurately.

It can be helpful to follow up with your provider’s office to confirm that the prior authorization request has been submitted and is being reviewed by your insurance company.

Step 2: The insurer reviews the request

The insurance company will then review the submitted information and compare it against the specific coverage requirements established by your health plan.

A standard prior authorization request may take about one week to process, while urgent requests are typically reviewed and decided within 72 hours or less.

Once a decision is reached, you, your healthcare provider, and your pharmacy will be notified of the outcome.

Step 3: The pharmacy notifies you to pick up the prescription

Once your Breztri prescription has been approved, the pharmacy will process the medication and notify you when it is ready for pickup.

If the prior authorization request is denied, many pharmacies will also inform you so you are aware before attempting to fill the prescription. This can help you understand any coverage issues and know what to expect when you pick up your medication.

What to do if your prior authorization is denied

If your Breztri prescription is denied even after your healthcare provider has completed and submitted the prior authorization request, contact your insurance company to understand the reason for the denial.

You can then ask your healthcare provider to submit an appeal letter along with any additional documentation or medical information required by your insurance plan. While prior authorization appeals are not always successful, they may provide another opportunity to get coverage approved.

If your request continues to be denied, discuss other covered medication options with your healthcare provider. You may also consider reviewing your insurance options during open enrollment to see if another plan better fits your healthcare needs.

For help managing costs, you may be able to use a SingleCare coupon for Breztri or check whether you qualify for the AstraZeneca patient assistance program to reduce your out-of-pocket expenses.

How to get Breztri while waiting for prior authorization

Breztri prior authorization requests are typically expected to be processed quickly, often within about 72 hours, because untreated COPD flare-ups can worsen breathing problems and may result in urgent care visits, emergency treatment, or hospitalization.

However, delays can sometimes happen during the approval or pharmacy processing stages. If you are waiting for prior authorization approval or for your prescription to be filled, there are steps you can take to help access Breztri while the process is ongoing.

Use a SingleCare coupon as a temporary option.
A free SingleCare prescription discount card may help reduce the out-of-pocket cost of Breztri while you wait for insurance approval. Breztri coupons available through SingleCare may lower the cash price at participating pharmacies. Keep in mind that SingleCare discounts cannot be combined with insurance, and any amount paid using the coupon will not count toward your insurance deductible. You can compare current prices at nearby pharmacies through the Breztri coupon page.
Ask about using separate inhalers temporarily.
The three active ingredients in Breztri are also available in separate inhaler medications. While using multiple inhalers may not be as convenient as a single combination inhaler, it may be an option while waiting for coverage approval. Talk with your healthcare provider about whether this approach is appropriate and use SingleCare coupons to help reduce medication costs.
Check for manufacturer savings and assistance programs.
You may qualify for assistance programs from AstraZeneca that can help lower the cost of Breztri. Breztri Zero Pay is available for eligible patients with commercial insurance, while AZ&ME may provide support for Medicare beneficiaries. Application reviews may take several days, so it is best to apply as early as possible.
Ask your healthcare provider about medication samples.
Some healthcare providers keep Breztri samples available for patients who need to begin treatment while waiting for insurance approval. A Breztri sample typically provides about one week of medication, which may help bridge the gap during the prior authorization process.

Expert takeaway

Leslie Greenberg, MD, associate professor of Community and Family Medicine at the University of Nevada, Reno Family Medicine Residency and a member of the SingleCare Medical Review Board, explains that while Breztri can be costly, it may be an important treatment option for many people with COPD.

Dr. Greenberg notes that some insurance companies may limit access to Breztri by requiring complex prior authorization processes, which can delay or prevent patients from receiving the medication. He recommends exploring more affordable medication alternatives when appropriate or considering whether a different insurance plan during open enrollment may provide better coverage.

Frequently asked questions

Does Breztri require prior authorization?

Coverage requirements vary depending on your insurance plan. Some insurance companies require prior authorization before approving Breztri, while others may cover the medication without requiring additional approval.

Is Breztri available as a generic?

No, Breztri is not currently available as a generic medication. Based on current patent information, a generic version of Breztri is not expected to become available until 2030 or later.

However, two of Breztri’s active ingredients—budesonide and formoterol fumarate—are available as generic medications that can be used in separate inhalers. The third ingredient, glycopyrrolate, is more difficult to obtain as a standalone generic option.

Is Breztri the same as Symbicort?

No, Breztri is not the same as Symbicort. While both inhalers contain budesonide and formoterol, they differ in the number of active ingredients they provide.

Symbicort is a dual-therapy inhaler that combines:

Budesonide (an inhaled corticosteroid, ICS)
Formoterol (a long-acting beta agonist, LABA)

Breztri is a triple-therapy inhaler that combines:

Budesonide (ICS)
Formoterol (LABA)
Glycopyrrolate (a long-acting muscarinic antagonist, LAMA)

The addition of glycopyrrolate makes Breztri a triple therapy option designed for certain patients who need an additional bronchodilator component.

Source: SingleCare

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