Bronchitol — Highmark

Initial criteria

• Member is age ≥ 18 years
• Diagnosis of cystic fibrosis (ICD-10: E84)
• Prescriber attests that the member has passed a Bronchitol Tolerance Test
• Prescriber attests that Bronchitol will be used in conjunction with standard therapies (e.g., bronchodilators, hypertonic saline, antibiotics, anti-inflammatory therapy, CFTR modulators, pancreatic enzymes)
• Member has experienced therapeutic failure, contraindication, or intolerance to hypertonic saline solution for inhalation

Reauthorization criteria

• Prescriber attests that the member experienced an increase in FEV1

Approval duration

up to 24 months