Ofev — CareFirst (Caremark)
Chronic fibrosing interstitial lung diseases with a progressive phenotype (progressive pulmonary fibrosis [PPF])
Initial criteria
- Member has completed a high-resolution computed tomography (HRCT) study of the chest that shows fibrosis affecting at least 10 percent of the lungs.
- Member has progressive disease (e.g., forced vital capacity [FVC] decline ≥10% of predicted value, worsening respiratory symptoms, increased extent of fibrosis on HRCT).
Reauthorization criteria
- Member is currently receiving treatment with Ofev.
Approval duration
12 months