Bronchitol — Medical Mutual

Cystic Fibrosis

Initial criteria

Patient is age ≥ 18 years; AND
Patient has tried hypertonic saline; AND
Patient has passed the Bronchitol Tolerance Test; AND
Patient will pre-medicate with a short-acting bronchodilator; AND
Medication is prescribed by or in consultation with a pulmonologist or a physician who specializes in the treatment of cystic fibrosis; AND
Medication is used as add-on maintenance therapy to improve pulmonary function

Patient is age ≥ 18 years; AND
Patient has tried hypertonic saline; AND
Patient has passed the Bronchitol Tolerance Test; AND
Patient will pre-medicate with a short-acting bronchodilator; AND
Medication is prescribed by or in consultation with a pulmonologist or a physician who specializes in the treatment of cystic fibrosis; AND
Medication is used as add-on maintenance therapy to improve pulmonary function; AND
Patient has experienced an adequate response to therapy, as evidenced by improvement in FEV1 and/or other lung function tests per the prescribing physician

365 days