Ofev — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Forced vital capacity is ≥ 40% of the predicted value; AND
• The diagnosis is confirmed by one of the following: Findings on high-resolution computed tomography indicates usual interstitial pneumonia OR A surgical lung biopsy demonstrates usual interstitial pneumonia; AND
• Medication is prescribed by or in consultation with a pulmonologist

Reauthorization criteria

• Patient is age ≥ 18 years; AND
• Patient has experienced a beneficial response to therapy over the last year while receiving Ofev (if < 1 year, response is from baseline prior to initiating Ofev); AND
• Medication is prescribed by or in consultation with a pulmonologist

Approval duration

1 year