Trikafta (elexacaftor/tezacaftor/ivacaftor) — United Healthcare
cystic fibrosis (CF)
Initial criteria
- Diagnosis of cystic fibrosis (CF)
- AND Documentation confirming the patient has at least one of the following responsive mutations in the CFTR gene: (1) F508del mutation OR (2) A mutation that is responsive based on clinical data OR (3) A mutation that is responsive based on in vitro data OR (4) A mutation that is responsive based on extrapolated data
- AND age ≥ 2 years
Reauthorization criteria
- Documentation of positive clinical response to Trikafta therapy (e.g., improved lung function, stable lung function)
Approval duration
12 months