Skip to content
The Policy VaultThe Policy Vault

Brinsupri (brensocatib)Medica

Non-cystic fibrosis bronchiectasis

Initial criteria

  • age ≥ 12 years
  • history of bronchiectasis diagnosed by chest computed tomography
  • EITHER (a) patient age ≥ 12 and < 18 years AND ≥ 1 pulmonary exacerbation in the last 12 months resulting in an antibiotic prescription OR (b) patient age ≥ 18 years AND ≥ 2 pulmonary exacerbations in the last 12 months resulting in an antibiotic prescription
  • respiratory symptoms not driven primarily by chronic obstructive pulmonary disease or asthma
  • patient does not have cystic fibrosis
  • patient is a current non-smoker
  • medication prescribed by or in consultation with a pulmonologist or infectious disease physician

Reauthorization criteria

  • age ≥ 12 years
  • patient does not have cystic fibrosis
  • patient is a current non-smoker
  • beneficial clinical response demonstrated (e.g., reduction in exacerbations, preservation of lung function, reduced cough, reduced sputum production, or less shortness of breath)
  • medication prescribed by or in consultation with a pulmonologist or infectious disease physician

Approval duration

1 year