ensifentrine — CareFirst (Caremark)

Initial criteria

• The requested drug is NOT being used for the relief of acute symptoms (i.e., as rescue therapy for the treatment of acute episodes of bronchospasm).
• The patient is an adult (age ≥ 18 years).
• The patient meets ONE of the following: current treatment with dual therapy (long-acting muscarinic antagonist [LAMA] and long-acting beta agonist [LABA]) OR triple therapy (LAMA, LABA, and inhaled corticosteroid [ICS]); OR inadequate treatment response to dual therapy (LAMA/LABA) OR triple therapy (LAMA/LABA/ICS); OR intolerance to dual therapy (LAMA/LABA) OR triple therapy (LAMA/LABA/ICS); OR contraindication that would prohibit a trial of dual therapy (LAMA/LABA) OR triple therapy (LAMA/LABA/ICS).

Reauthorization criteria

• The requested drug is being prescribed for the maintenance treatment of COPD in an adult patient.
• The patient has experienced a positive clinical response to therapy (e.g., improvement in forced expiratory volume in one second [FEV1], decrease in respiratory symptoms, fewer exacerbations) OR has not experienced worsening of symptoms since the start of therapy (e.g., increased shortness of breath, coughing, wheezing/chest tightness, fatigue).

Approval duration

12 months