Symdeko (tezacaftor/ivacaftor and ivacaftor) — Medical Mutual
Cystic Fibrosis (CF), continuation of therapy
Initial criteria
- Patient has been using Symdeko for at least 6 months; AND
- Patient meets all criteria for new starts
Reauthorization criteria
- Compared to baseline, patient has experienced clinical benefit in response to therapy such as: i. Increase in weight; OR ii. Improvement in sweat chloride; OR iii. Improvement in predicted FEV1 or other lung function tests; OR iv. Decrease in amount/frequency of pulmonary exacerbations; OR v. Decrease in amount/frequency of pulmonary infections; OR vi. Decrease in hospitalizations
Approval duration
1 year