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OfevMedical 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