Trikafta (elexacaftor/tezacaftor/ivacaftor) — CareFirst (Caremark)

Cystic fibrosis in patients aged ≥ 2 years who have at least one F508del CFTR mutation or another CFTR mutation responsive based on clinical and/or in vitro data

Initial criteria

Prescribed by or in consultation with a pulmonologist
Genetic testing was conducted to detect a mutation in the CFTR gene
The member has one of the listed approved CFTR gene mutations including F508del or another mutation responsive to Trikafta
The member is at least 2 years of age
Trikafta will not be used in combination with another CFTR modulator (e.g., Alyftrek, Kalydeco)

Reauthorization criteria

Member is experiencing benefit from therapy as evidenced by disease stability or disease improvement (e.g., improvement in FEV1 from baseline)

Approval duration

12 months