Ofev — Medical Mutual
Interstitial Lung Diseases, Chronic Fibrosing with a Progressive Phenotype
Initial criteria
- Patient is age ≥ 18 years; AND
- Forced vital capacity is ≥ 40% of the predicted value; AND
- According to the prescriber patient has fibrosing lung disease impacting > 10% of lung volume on high-resolution computed tomography; AND
- According to the prescriber patient has clinical signs of progression (examples: forced vital capacity decline ≥ 10% of predicted value, or forced vital capacity decline ≥ 5% to < 10% with worsening symptoms and/or worsening imaging); 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