Cayston (aztreonam for inhalation solution) — CareFirst (Caremark)

Initial criteria

• Member has cystic fibrosis
• Member age ≥ 2 years
• Pseudomonas aeruginosa is present in airway cultures OR member has a history of Pseudomonas aeruginosa infection or colonization in the airways

Reauthorization criteria

• Member is experiencing benefit from therapy as evidenced by disease stability or disease improvement
• Indication remains as listed in coverage criteria section

Approval duration

12 months