Brinsupri (brensocatib) — Highmark
non-cystic fibrosis bronchiectasis (NCFB)
Initial criteria
- age ≥ 12 years
- Diagnosis of non-cystic fibrosis bronchiectasis confirmed by computed tomography (CT)
- Member has experienced at least one of the following symptoms consistent with bronchiectasis: cough on most days of the week OR chronic sputum production OR a history of recurrent respiratory infections
- For members age ≥ 18 years: has experienced at least two exacerbations in the previous 12 months that led to antibiotic treatment
- For members age 12 to <18 years: has had at least one pulmonary exacerbation in the previous 12 months that led to antibiotic treatment
Reauthorization criteria
- Member has experienced positive clinical response to therapy
Approval duration
12 months