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cystic fibrosis

Initial criteria

  • age ≥ 6 years
  • diagnosis of cystic fibrosis
  • has at least one F508del mutation or another responsive mutation in the CFTR gene (see Table 1) as detected by an FDA-approved test

Reauthorization criteria

  • Documented improvement or stabilization of forced expiratory volume (FEV1) compared to baseline FEV1
  • Increased Body Mass Index
  • Decreased pulmonary exacerbations
  • Improved quality of life as demonstrated by Cystic Fibrosis Questionnaire

Approval duration

initial up to 6 months (12 months for Delaware Commercial fully-insured and ACA members); reauthorization up to 12 months