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The Policy VaultThe Policy Vault

lumacaftor/ivacaftorUnited Healthcare

cystic fibrosis (CF) in patients homozygous for the F508del mutation in the CFTR gene

Initial criteria

  • Diagnosis of cystic fibrosis (CF)
  • Documentation confirming the patient is homozygous for the F508del mutation in the CFTR gene
  • age ≥ 1 years

Reauthorization criteria

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

Approval duration

12 months