TOBI Solution for Inhalation — United Healthcare

Initial criteria

• One of the following:
• Diagnosis of cystic fibrosis (CF)
• OR
• Both of the following:
• Diagnosis of noncystic fibrosis bronchiectasis
• AND
• One of the following:
• Three or more exacerbations per year
• OR
• Two or more exacerbations requiring hospitalization per year
• AND
• Lung infection with positive culture demonstrating Pseudomonas aeruginosa infection

Reauthorization criteria

• Documentation of positive clinical response to Bethkis, Kitabis Pak, TOBI Nebulizer Solution, TOBI Podhaler, or tobramycin solution for inhalation therapy

Approval duration

12 months