Alyftrek (vanzacaftor/tezacaftor/deutivacaftor) — United Healthcare

Initial criteria

• Diagnosis of cystic fibrosis (CF)
• Documentation confirming the patient has at least one of the following responsive mutations in the CFTR gene: F508del mutation; a mutation that is responsive based on clinical data; a mutation that is responsive based on in vitro data; or a mutation that is responsive based on extrapolation data
• age ≥ 6 years

Reauthorization criteria

• Documentation of positive clinical response to Alyftrek therapy (e.g., improved lung function, stable lung function)

Approval duration

12 months